Method of endoscopic treatment of barrett's esophagus

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery, and can be used for endoscopic treatment of Barrett's esophagus in surgical hospitals. For this purpose endoscopically ligated is section of metaplasma esophagus epithelium by means of ligator of varicose esophagus veins on 6 ligatures-rings of model "Shooter" by firm Wilson Cook MBL-6-PK. Ligatures are put onto distal end of endoscope by aspiration into ligator and mechanical clamping of metaplasma mucous by ligature-ring with further ischemisation and rejection of specified affected section of esophagus.

EFFECT: method allows to control complete grip of altered esophagus mucous membrane, avoid unhealing for a long time, thermally conditioned ulcer defect.

1 ex, 5 dwg

 

The invention relates to medicine, namely to surgery, and can be used for endoscopic treatment of Barrett's esophagus surgical hospitals.

Barrett's esophagus is the most serious complication of gastroesophageal reflux disease (GERD), is manifested by the appearance of metaproterenol epithelium in the mucosa of the distal esophagus, which is many times increases the risk of developing esophageal cancer. The development of medicine in General and, in particular, endoscopy, contributed to the emergence of new minimally invasive surgical treatment metaplasia of the epithelium of the mucosa of the distal esophagus. Previously known method of thermal coagulation areas of metaplasia of the esophageal mucosa.

Similar to the proposed method is the method of thermal coagulation areas of metaplasia of the epithelium of the mucosa of the distal esophagus using electrocautery or argon-plasma enhanced electrocoagulation and consists in the destruction of sites metaproterenol mucous membrane of the esophagus.

The disadvantages are the counterpart:

1. Uncontrolled depth of thermal effects on the mucous membranes and as a result, the development of different types of complications: esophageal strictures, perforation of the esophagus, phenomenon, dysphagia, fever, pleural effusion. The number of Oslon the deposits when performing this method reaches of 57.5% (Schulz N., Miehlke s, Antos D., et al.: Ablation of Barrett''s epithelium by endoscopic argon plasma coagulation in combination with high-dose omeprazole. Gastrointest Endosc 2000, 51: 659-663).

2. As with all electrosurgical interference, this method with great caution must be used in patients with metallic implants and artificial pacemakers.

3. The high frequency of recurrences of from 22 to 30% (Grade AJ, Shah IA, Medlin SM, et al.: The efficacy and safety of argon plasrna coagulation therapy in Barrett''s esophagus. Gastrointest Endosc 1999, 50: 18-22).

The purpose of the invention is to develop new safe and effective minimally invasive method for the treatment of Barrett's esophagus by controlled removal of the modified metaproterenol mucous membrane of the esophagus.

The essence of our proposed method is that endoscopically are ligated plot metaproterenol the esophageal epithelium using ligature varicose veins of the esophagus 6 ligatures-rings model "Shooter" by Wilson Cook MBL-6-PK worn on the distal end of the endoscope, by aspiration in Ligator and mechanical clamping ligature-ring area metaproterenol mucosa, with subsequent semiseria and rejection of this affected area of the esophagus.

The method is as follows.

Figure 1 shows a General view of Ligator varicose veins of the esophagus 6 ligatures-rings - (A) the model of the "Shooter" by Wilson Cook MBL-6-PK worn n the distal end of the endoscope.

Figure 2 shows a fragment of the endoscopic examination of the esophagus with land - (B) metaproterenol epithelium lining of the esophagus.

The plot metaproterenol epithelium of the mucosa of the esophagus is supplied to the endoscope with a pre-mounted on the distal end of the silicone transparent cylinder that has ligatures-rings. Figure 3 by aspiration into the lumen of the transparent cylinder retracts plot metaproterenol epithelium of the mucous membrane of the esophagus, passing monitored the adequacy of retracting into the cylinder of the esophageal mucosa to the borders metaproterenol plot. As soon as the plot metaproterenol mucous (or its fragment) will completely fill transparent cylinder, by means of the transport device from the exterior of the transparent cylinder is reset ligature-ring - And on the basis of venutolo part of mucosa (Figure 4). This area of mucous membrane, in the form of a "mushroom"due to local insufficiency of tissues, rejected on the 3-4th day. Emerging at this place ulcerative defect - G (Figure 5) rubtsuyutza on day 5-7.

For better healing of the ulcer and normal mucosa of esophagus, the patient is assigned to receive proton pump inhibitors and enveloping drugs in high doses.

The operation is carried out either without preparation, or after administration of the drugs, oscestudy on mucous of esophagus to remove any existing inflammation and improve the results of operations.

The advantages of this method:

1. No uncontrolled thermal effects that can cause complications.

2. Controlled and complete capture of the modified mucous membrane of the esophagus.

3. The lack of a long time healing, thermally caused the ulcer.

The method was tested in MUSES GB No. 2 "CMLDA" in Krasnodar. In the period from may 2008 to April 2009, this method produced the treatment of 7 patients. Complications in the postoperative period. The adequacy of the removal of the affected mucous fully achieved in all patients. Signs of recurrence of the disease in any patient not identified.

Clinical example:

Patient B., 24, enrolled in MUS GB No. 2 "CMLDA" Krasnodar 21.05.08, complaining of heartburn, sour belching, heaviness in the epigastrium, decreased appetite. From the anamnesis: considers himself to be patient since 2004, when the first symptoms of heartburn. Took enveloping means (Almagell, Maalox), prokinetic (Motilium). It was noted a temporary improvement. In 2008, the condition of the patient deteriorated. Appealed to the MUSES GB No. 2 "CMLDA" Krasnodar for examination and treatment.

When esophagogastroduodenoscopy (21.05.08 g): the Esophagus is freely pass, slimy pale pink. In n/3 is part of valueoptions mucous type of "flame" with a length of 1.5 cm from the card is I. From valueoptions of the esophageal mucosa biopsy. Cardia 39 cm gaping. From the side of the stomach and duodenum revealed no pathology.

Conclusion: Distal catarrhal reflux esophagitis. Hernia, complicated Barrett's esophagus. A biopsy.

PIP No. 55163-66: chronic, moderate esophagitis with elements of colonic metaplasia of the mucous membrane of the esophagus. Morphological picture does not contradict histologically, the diagnosis of Barrett's esophagus.

26.05.08, the patient produced endoscopic ligation site metaproterenol the esophageal epithelium using ligature under General anesthesia. On the affected area has been planned with two ligatures-rings. The postoperative period was uneventful. Was the prescribed treatment, coating agents, proton pump inhibitors, prokinetics in standard doses.

When the control fibrogastroduodenoscopy 3 day determined rejection of the very area with the formation of the surface of the ulcer, covered with fibrin. Esophagogastroduodenoscopy (29.05.08,): the Esophagus is freely pass, the elastic wall. The mucous membrane is pale pink in color, hyperemic in n/3. On the right wall n/a 3 esophageal ulcer after the ligation site metaproterenol mucous tinged with bright fibrin size of 0.7×1,0 see Cardia 39 cm, gaping. Signs of complications were found. Enclosed is e: Distal catarrhal reflux esophagitis. Hernia UNDER. Ulcer of the distal esophagus after the ligation site metaproterenol mucosa (Barrett's esophagus).

Dynamic monitoring of the patient during the period from 2008 to 2009 in the field of ligating celebrated fine n/I scar recurrence of Barrett's esophagus was not detected.

Medical social efficiency:

The treatment of this category of patients suitable for all patients with contraindications to electrosurgical effect: the presence of artificial pacemakers, artificial joints, metal inserts. The use of original technology for removal metaproterenol mucosa with Barrett's esophagus significantly improves the results of treatment of these patients. The proposed method, due to the rapid healing, absence of complications and small terms of the patient's stay in hospital, has a high economic efficiency

A method of endoscopic treatment of Barrett's esophagus in patients with complicated gastroesophageal reflux disease, characterized in that endoscopically are ligated plot metaproterenol the esophageal epithelium using ligature varicose veins of the esophagus 6 ligatures-rings model "Shooter" by Wilson Cook MBL-6-PK, worn on the distal end of the endoscope, by aspiration in Ligator and mechanical is the first clamping ligature-ring area metaproterenol mucosa with subsequent semiseria and rejection of this affected area of the esophagus.



 

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