Author/Editor		Paquet, Karl-Joseph
Title		Endoluminal endoscopic electrosurgical managementof postoperative anastomotic strictures of the upper gastointestinal tract
Translated title		Endoluminalna endoskopska elektrokirurška oskrba pooperativne anstomozne strikture v zgornjih prebavilih
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 2, št. 4
Publication year		1997
Volume		str. 77-81
Language		eng
Abstract		Background. A new technique of endoluminal electrosurgical management of postoperative anastomotic strictures in the upper gastrointestinal tract is presented. Patients and methods. Over a period of 5 years, 15 consecutive patients, 9 men and 6 women, were followed up for several weeks or months after gastrectomy performed for: resection of the cardia, or the terminal or middle third of the oesophagus because of carcinoma, resection for achalasia with dysplasia, and management of resistant peptic stenosis in the terminal oesphagus. The anastomoses were located in the neck in 2 patients, intrathoracically in 9, and partially intrathoracically or at the level of the diaphragm in 4 patients. Technique 1 consisted of resection of the anastomotic scar tissue with completely extended, and then subtotally extended polypectomy snare, similar to polypectomy. Technique 2 involved placement of the middle part of a partially open or subtotally closed polypectomy snare in the stenosis, followed by a longitudinal incision at 3, 7 and 11 o'clock, to a depth of 3 to 10 mm. Results. Minor bleeding occurred in 3 cases (20%), but stopped spontaneously in the course of endoscopy. During the follow-up period of at least one year, there were 2 recurrences: one 1 month and another 3 months after the procedure; both were managed successfully using the same technique, but there was further recurrence. Conclusion. The described techniques are safe, easy to learn and simple to perform. They are effectively used in the management of postoperative strictures to obviate the need for reoperation. They afford definitive treatment in the majority of cases.
Summary		Izhodišča. Prikaz nove tehnike oskrbe pooperativnih anastomoznih striktur zgodnjih prebavil z uporabo endoluminalne endoskopske elektrokirurgije. Bolnik in metode. V obdobju petih let smo obravnavali 15 bolnikov, pri katerih je bila narejena gastrektomija zaradi naslednjih razlogov: resekcija kardije zaradi karcinoma, resekcija spodnje ali srednje tretjine požiravnika zaradi karcinoma, resekcija zaradi ahalazije z displazijo ali zaradi zdravljenja neodzivne peptične stenoze končnega dela požiralnika. Anastomoze so bile narejene na naslednjih mestih: pri dveh bolnikih v vratu, pri devetih intratorakalno in delno intratorakalno ali na ravni diafragme pri štirih bolnikih. S tehniko 1 je bilo mogoče odstraniti brazgotinsko tkivo na anastomozi. Tehnika je podobna zankasti odstranitvi polipa in jo je mogoče ponavljati. Pri postopku 2 je bila v predel strikture uvedena delno odprta ali skoraj povsem zaprta žična zanka. Na poziciji 3., 7. in 11. ure je bila narejena vzdolžna incizija, globoka 3-10 mm. Rezultati. V treh primerih (20%) je bila prisotna rahla krvavitev, ki se je umirila spontano med endoskopskim posegom. Med enoletnim opazovalnim obdobjem sta bili dve ponitivti, prva po enem mesecu in druga po treh mesecih. Obe sta bili razrešeni na enak način, brez ponovitve. Zaključek. Tehniki sta lahki, hitro učljivi, izvedba pa enostavna. Primarni sta za rezreŠevanje pooperativnih striktur tako, da ponovna operacija ni potrebna. V večini primerov poseg dokončno razreši problem strikture.
Descriptors		GASTRECTOMY ANASTOMOSIS, SURGICAL ESOPHAGUS ESOPHAGEAL STENOSIS ELECTROCOAGULATION