Capacity of flexible endoscopy in subepithelial esophageal tumors

Aim of the study was to investigate the results of endoscopic diagnostics and peroral operative endoscopy in subepithelial esophageal tumors. Material and methods. Data of 21 patients underwent flexible endoscopic interventions for subepithelial esophageal tumors (SET) from 2016 till 2019 were analyzed. Main endoscopic methods to reveal and characterize tumors preoperatively are examination in white light, narrow light spectrum imaging, radial endoscopic ultrasonographic scanning. Tumors from 8 till 40 mm in maximal dimension removed by endoscopic mucosal resection (2 tumors in 1 patient), tunnel dissection (13 cases) or endoscopic submucosal dissection (7 cases). The additional endoscopic ultrasonography was demanded intraoperatively in 2 cases of difficult tumor location and blurry visualization. Results and discussion. Subepithelial esophageal tumors are mainly diagnosed occasionally in patients without symptoms related to tumor. Suspicion of the tumor was based on routine esophagogastroduodenoscopy. Following endoscopic ultrasonography of planned esophageal segment allowed rejecting or confirming the lesion (21 patients), evaluating its echoscopic structure, size, growth direction, intramural location and connection to wall layers to make an assumption related to tumor morphology, to plan way of tumor removal. We choose interventions in depends on combination of available tumor features. Technical success of endoscopic interventions with use of flexible endoscope under this approach is noted in all the patients. So endoscopic methods are important for primary and detailed diagnostics and also effective for operative treatment in cases of appropriate indications

Endocopic diverticuloesophagotomy in dysphagia of combined genesis in aged patient (сlinical case)

Zenker’s pharyngeal-esophageal diverticulum is more common in elderly patients, manifests itself with dysphagia and is dangerous with aspiration complications. The clinical case describes a combination of the first detected large Zenker diverticulum, pneumonia, neurological symptoms in an 86-year-old patient with aphagia. Despite the combination of aggravating factors, oral endoscopic ventriculostomy was performed using a flexible endoscope. After surgery: there are no violations of the act of swallowing. The patient eats liquid and semi-liquid food. No complaints of dysphagia were presented. At x-ray control, there is some delay of the contrast agent in the diverticulum, which does not prevent its emptying. The case demonstrates the effectiveness of endoscopic intervention in large-sized Zenker diverticulum, the possibility of its implementation in age-related patients with combined pathology, including neurological deficiency, preserving the patient’s chance of recovery

ESTIMATION OF GASTRIC TRANSPLANT MORPHOFUNCTIONAL STATUS IN REMOTE PERIOD AFTER ESOPHAGOPLASTY

35 patients were examined in 3-10 years after transhiatus esophageolpastics on account of esophageal achalasia were examined. It was determined at X-ray and. endoscopic examination that transplant held tubular shape without considerable deformations, tended to the atrophy and moderate focal hyperemia of mucous tunic and also underwent bile reflux. In 5 cases we revealed first time appeared stenosis of esophagogastric anastomosis, permeability of which was restored by endoscopic method in all patients. Dystrophic changes and. high secretion of superficial epithelium dystrophy and. focal atrophy of fundus glands, cellular infiltration of stroma, thickening and. fibrosis of muscular layer of mucous tunic of gastric tube were revealed microscopically in biopsy material. Revealed morphofunctional peculiarities of transplant testify to the realization of a complex of adjustments and. pathological reactions in it and. dynamic control of course of these reactions is considered necessary at the patients' mass health examination

GASTROINTESTINAL INDEX OF LIFE QUALITY OF PATIENTS AFTER ESOPHAGOPLASTY

After one-stage transhiatal esophagoplasty more than 1 year ago for benign esophageal diseases GIQLI questionnaire was completed by 30 patients after esophageal extirpation with gastric tube esophagoplasty and 25 patients after bypassing esophagoplasty with left colon. Based on type of esophagoplasty and. follow-up period. (1-3 years, 3 and. more years) patients were divided up into 4 groups. Statistic analysis revealed evidently (

VALVULAR BRONCHIAL CLOSURE IN THE TREATMENT OF BRONCHOPLEURAL FISTULAS

Aim of the study: the use of the valvular bronchial blocking technique in the treatment of bronchopleural fistulas in patients with thoracic pathology. Material and methods. During the period from 2012 to 2017, the valvular bronchial blocking technique was used in the treatment of 76 patients with bronchopleural fistulae (men 68, women 8). The age of patients is 16 to 82 years. In 24 patients, the indication for bronchial blocking was complications of thoracoscopic operations with bullous pulmonary emphysema. In a smaller number of cases (21), pneumothorax occurred in patients with COPD. Purulent diseases of the lungs and pleura caused a blockage in 24 patients. Results. Medlung blockers were used to treat patients. The blocker was placed in the "targeted" bronchus under local anesthesia while performing fibroblochoscopy. In all cases, the blocker was established. Reduction or cessation of air leakage through drainage from the pleural cavity occurred within a period of 5 hours to 1.5 days. In patients with poorly positive dynamics, correction of the blocker standing and additional blocking were performed, which resulted in good outcomes in 4 patients. A positive result was obtained in more than 85 % of patients. In 10 cases, no effect was obtained, which required surgical intervention. The duration of the blocker in the bronchus was from 4 days to 4 months. When removing the blocker, there were no complications. Conclusion. The technique of valvular bronchial blocking allowed to improve the results of treatment of patients with thoracic profile with various diseases complicated by the appearance of bronchopleural fistula, including complications of the postoperative period

Endoscopic interventions in tumor of trachea

OBJECTIVE. The authors assessed possibilities of endoscopic methods for restoration and maintenance of trachea patency. MATERIAL AND METHODS. The article presents results of endoscopic treatment of 26 patients with trachea tumors. Tumor lesions of trachea was the main cause of contraction (primary tracheal cancer had 9 patients; esophageal cancer with invasion inside trachea - 5 patients; relapse of trachea cancer - 1case; relapse of larynx cancer - 1 case; lung cancer with invasion inside trachea - 3 cases; thyroid cancer - 2 patients). RESULTS. Endoscopic interventions were applied in order to restore the trachea patency such as tumor bougienage, electro-excision, tumor cutting, trachea stenting. There was observed bleeding in 3 patients, though it didn’t influence on operation approach. The patency of trachea was restored in all cases. Trachea stenting was performed in 19 patients as a preventive measure (silicone stents in 4 cases; self-expandable metal stent in 15 cases). Medical care remained actual in both restoration and trachea patency supporting. CONCLUSIONS. Endoscopic methods showed the high efficacy in treatment of patients with trachea tumors

TRACHEO-ESOPHAGEAL STENTING IN THEIR TUMOR STENOSIS

The article presents the results of diagnostics and treatment of 6 patients, whom the trachea-esophageal stenting was performed (5 men, 1 woman). The age of patients was from 49 to 78 years old. The indication to stent implantation was in cases of esophageal cancer in 4 patients. Metastatic lesions of the lymph nodes of the mediastinum was the reason of esophageal stenosis after previously performed surgery (type of Lewes operation) in one case. Another reason of surgery was central cancer of the right lung with invasion to the mediastinum, trachea and esophagus compression in one patient. Treatment management was determined by presence of respiratory failure and dysphagia evidence. The trachea stenting was carried out as the first stage of treatment in case of respiratory failure. The esophageal stenting was made in case of dysphagia. There weren’t any complications. The trachea-esophageal patency was restored

ASSESSMENT OF THE RESULTS OF ESOPHAGOGASTROPLASTY OF SCARRY STRICTURE OF THE ESOPHAGUS AND ESOPHAGEAL ACHALASIA

Department of hospital and pediatric surgery, Novosibirsk State Medical University OBJECTIVE. The authors made a complex assessment of functioning of the artificial esophagus, which was formed from the stomach. The pathological study of biopsy material of mucous coat of the stomach was carried out at different terms after surgery. MATERIALS AND METHODS. The research analyzed the results of esophagogastroplasty in cases of scarry strictures of the stomach after burns and esophageal achalasia in 101 patients. All the patients underwent extirpation of the esophagus with the gastric tube plasty. RESULTS. There weren’t noted any complications with gastric graft functioning. These data were confirmed by X-ray and endoscopy. The structural reorganization of the mucous coat with signs of atrophy was revealed according to the data of pathologic research. CONCLUSIONS. The authors indicated the necessity of the dynamic follow-up of the patients after esophagoplasty

Endoscopic technologies in treatment of patients with purulent diseases of lungs and pleura

The objective of the study is to evaluate the efficacy of valvular bronchoblocation in the treatment of patients with purulent diseases of the lungs and pleura.Material and methods. 28 patients aged 15 to 66 years with bronchopleural fistulas were treated.Results. Positive dynamics was observed in 23 patients during the first 10–15 hours after blocking (cessation or reduction of air leakage through drainage or into the residual pleural cavity). In four patients, it was possible to stop the purulent-inflammatory process in the pleural cavities and perform thoracomyoplasty with good clinical results. In the presence of an inconsistency of the stump of the bronchus in 4 out of 5 patients, it was possible to effectively close the fistula and eliminate the residual pleural cavity.Conclusion. The use of valvular bronchoblocation in patients with acute purulent diseases of the lungs and the pleura allows achieving good results. The objective of the study is to evaluate the efficacy of valvular bronchoblocation in the treatment of patients with purulent diseases of the lungs and pleura.Material and methods. 28 patients aged 15 to 66 years with bronchopleural fistulas were treated.Results. Positive dynamics was observed in 23 patients during the first 10–15 hours after blocking (cessation or reduction of air leakage through drainage or into the residual pleural cavity). In four patients, it was possible to stop the purulent-inflammatory process in the pleural cavities and perform thoracomyoplasty with good clinical results. In the presence of an inconsistency of the stump of the bronchus in 4 out of 5 patients, it was possible to effectively close the fistula and eliminate the residual pleural cavity.Conclusion. The use of valvular bronchoblocation in patients with acute purulent diseases of the lungs and the pleura allows achieving good results