scholarly journals Application of biological welding as a method of treatment of esophageal metaplasia

2020 ◽  
Vol 87 (5-6) ◽  
pp. 9-12
Author(s):  
V. V. Tyselskyi ◽  
B. G. Bondarchuk ◽  
V. A. Hordovskyi ◽  
A. B. Kebkalo
Keyword(s):  
Barrett’S Esophagus ◽  
High Frequency ◽  
Barrett's Esophagus ◽  
Balloon Dilation ◽  
Disease Recurrence ◽  
Nodule Development ◽  
Mucosal Regeneration ◽  
Group I ◽  
Group Ii ◽  
Living Tissues

Objective. To estimate a high-frequency welding of the living tissues as a variant of treatment for the Barrett’s esophagus. Materials and metods. Retrospective analysis of the treatment results was conducted in 73 patients, suffering Barrett’s esophagus, in 36 of whom the argon-plasm coagulation was performed (Group I), while in 37 (Group II) - a high frequency welding of living tissues. Into the investigation the patients with a short-segment Barrett’s esophagus C2-3M3-4 (the Prague Classification, 2004 yr) and a high-grade dysplasia without a nodule development (VI World Congress of International Society for Diseases of the Esophagus (ISDE) were included. Results. In patients of Group I a severe esophageal edema have occurred in accordance to endoscopic ultrasonography data. In this Group in 5 (13.89%) patients after performance of the argon-plasm coagulation esophageal stenosis was observed, corrected by application of the balloon dilation. In 8 (22.22%) patients of this Group the disease recurrence have occurred, necessitating performance of additional séance of the argon-plasm coagulation. In patients of Group II the above mentioned inflammatory signs were less pronounced, and mucosal regeneration have proceeded more rapidly, than in patients of Group I - during 53 and 115 days, accordingly. The disease recurrence was noted in 2 (5.41%) patients of Group II only. Conclusion. High-frequency welding of living tissues constitute a safe and effective method of treatment in patients, having esophageal metaplasia.

Anti reflux surgery is needed after endoscopic treatment for Barrett’s esophagus

2021 ◽  
Vol 93 (5) ◽  
pp. 1-5
Author(s):  
Volodymyr Tyselskyi ◽  
Andrey Kebkalo ◽  
Vitaliy Poylin ◽  
Olga Tkachuk
Keyword(s):  
Barrett’S Esophagus ◽  
High Frequency ◽  
Endoscopic Treatment ◽  
Barrett's Esophagus ◽  
Antireflux Surgery ◽  
Esophageal Mucosa ◽  
Endoscopic Techniques ◽  
Stratified Squamous Epithelium ◽  
Living Tissues

Introduction: Barrett's esophagus – is an acquired condition that develops as a result of replacement of normal stratified squamous epithelium in the lower part of the esophagus with columnar epithelium. Barrett's esophagus is considered to be complication by gastroesophageal reflux disease (GERD). Various endoscopic techniques have been shown to be successful in treatment of this condition. However, long term success in preventing further dysplasia is not clear. Biological welding - controlled action of high frequency current on living tissues has been used in to stop gastrointestinal bleeding, ablation of small intestinal metaplasia of the esophageal mucosa Objective: The goal of this study is to evaluate success of endoscopic techniques in treatment of Barrett’s esophagus and need for subsequent surgical intervention in patients with GERDcomplicated by Barrett's esophagus. Materials and methods: Patients with Barrett's esophagus C1-3M2-4 (Prague classification in 2004) and high dysplasia without nodules, as well as confirmed GERD without hiatal hernia were included. Endoscopic treatment was performed by argonoplasmic coagulation (APC) and high-frequency welding of living tissues (HFW). In the dynamics of patients re-examined. Patients with recurrence of metaplasia and high De Meester index (˃ 100) underwent antireflux surgery - crurography and Nissen fundoplication with a soft and short cuff. Results: A total of 89 patients were included in the study, of which 81 were reexamined after ablation of Barrett's esophagus. In 12 patients, a relapse of small bowel type metaplasia was recorded. Nine patients underwent two-stage treatment - first, a second session of ablation of the esophagus, and at the second stage, antireflux surgery. 3 patients refused surgical treatment and underwent only a second ablation session. All patients received drug therapy - prokinetics and proton pump inhibitors. 3 months after the operation, the pH metry was repeated, which showed the normalization of the De Meester index, and as a result, the patients had no complaints such as heartburn, chest pain, dysphagia, which significantly improved their quality of life. esophagogastroduodenoscopy and biopsy of the mucous membrane of the lower third of the esophagus in accordance with the Seattle Protocol. After examining the histological material, no metaplasia zones were recorded. Conclusions: Antireflux surgery is required as part of the treatment of Barrett’s esophagus to prevent further dysplasia and development of esophageal cancer.

scholarly journals Correction of cardioesophageal transition as a stage of treatment after endoscopic welding of esophageal metaplasia

2021 ◽  
Vol 25 (2) ◽  
pp. 296-300
Author(s):  
V. V. Tyselskyi ◽  
A. B. Kebkalo
Keyword(s):  
Barrett’S Esophagus ◽  
High Frequency ◽  
Barrett's Esophagus ◽  
Antireflux Surgery ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Severe Dysplasia ◽  
Esophageal Mucosa ◽  
Living Tissues ◽  
Endoscopic Methods

Annotation. Barrett’s esophagus is an acquired condition that develops as a result of the replacement of normal stratified squamous epithelium in the lower part of the esophagus by columnar epithelium. Barrett’s esophagus is considered a complication of gastroesophageal reflux disease (GERD). It has been shown and proven that various endoscopic methods are successful in treating this condition. However, long-term success in preventing further metaplasia and dysplasia is incompletely studied. Biological welding – controlled action of high frequency current on living tissues. It is used to stop gastrointestinal bleeding, ablation of small intestinal metaplasia of the esophageal mucosa. The aim of this study was to evaluate the success of endoscopic treatments for Barrett's esophagus and the need for further surgery in patients with GERD complicated by Barrett’s esophagus. Patients with Barrett’s esophagus C1-3M2-4 (Prague classification 2004) and severe dysplasia without nodule, as well as confirmed GERD without esophageal hernia were included. A total of 98 patients were included in the study, of whom 89 were re-consulted and examined after primary Barrett's esophageal ablation. Endoscopic treatment was performed by argon-plasma coagulation (APC) and high-frequency welding of living tissues (HFW). In the dynamics of patients were re-examined. Patients with recurrent metaplasia and a high DeMeester index (˃100) underwent antireflux surgery – crurography (if necessary) and Nissen fundoplication with a soft and short cuff. Recurrence of small bowel metaplasia was recorded in 15 patients. 12 patients underwent a two-stage treatment: first a second session of esophageal ablation, and in the second stage - antireflux surgery. 2 patients refused surgical treatment and underwent only the second session of ablation. All patients received drug therapy – prokinetics and proton pump inhibitors. Three months after surgery, pH metry was performed again, which showed normalization of the DeMeester index, as a result of which patients had no complaints such as heartburn, chest pain, dysphagia, which significantly improved their quality of life. Esophagogastroduodenoscopy and biopsy of the mucous membrane of the lower third of the esophagus according to the Seattle protocol was also performed. After examination of the histological material of metaplasia zones were not recorded. It is concluded that antireflux surgery is required as part of Barrett’s esophageal treatment to prevent further dysplasia and the development of esophageal cancer.

Volumetric laser endomicroscopy in Barrett’s esophagus: interobserver agreement for interpretation of Barrett’s esophagus and associated neoplasia among high-frequency users

2017 ◽  
Vol 86 (1) ◽  
pp. 133-139 ◽  
Author(s):  
Arvind J. Trindade ◽  
Sumant Inamdar ◽  
Michael S. Smith ◽  
Kenneth J. Chang ◽  
Cadman L. Leggett ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
High Frequency ◽  
Barrett's Esophagus ◽  
Interobserver Agreement

scholarly journals COMPARATIVE EVALUATION OF THE RESULTS OF SURGICAL TREATMENT OF ACUTE ASCENDING THROMBOPHLEBITIS OF THE GREAT SAPHENOUS VEIN USING THE ENDOVASCULAR HIGH-FREQUENCY WELDING TECHNIQUE AND TRADITIONAL TECHNIQUE

2020 ◽  
Vol 73 (4) ◽  
pp. 638-641
Author(s):  
Serhiy I. Savolyuk ◽  
Valentyn A. Khodos ◽  
Roman A. Herashchenko ◽  
Vladyslav S. Horbovets
Keyword(s):  
Saphenous Vein ◽  
High Frequency ◽  
Comparative Evaluation ◽  
Great Saphenous Vein ◽  
Pain Syndrome ◽  
Surgical Operation ◽  
Electric Welding ◽  
Group I ◽  
Group Ii ◽  
Welding Technique

The aim of the study was to conduct a comparative evaluation of the effectiveness of surgical treatment of acute ascending thrombophlebitis of the great saphenous vein using the endovascular high-frequency welding technique and traditional phlebectomy. Materials and methods: Two groups were formed in the conducted study. Group I included patients (n=42) with the acute ascending thrombophlebitis of the great saphenous vein, in whom their thrombosed great saphenous vein was removed using the endovascular high-frequency welding technique. As a source of current, an EK300M1 Svarmed electric welding machine (Ukraine) was used. Electric welding of a thrombosed vein segment was carried out using the endovenous electric welding catheter. Group II included patients (n=31) with the acute ascending thrombophlebitis of the great saphenous vein, who underwent the traditional phlebectomy of the thrombosed great saphenous vein according to Babcock’s technique. Results: In group I no patient revealed presence of pain syndrome with significant intensity during the postoperative period. An infiltrate along the coagulated segments of the great saphenous vein, postoperative oedema and paresthesiae were observed in considerably fewer cases from group I versus group II (р=0.0005, р=0.0001, р=0.0018). During their follow-up for more than 12 months, 2 (4.76 %) of 42 patients from group I revealed partial recanalization of the great saphenous vein (р=0.632). In group I the postoperative inpatient period was 1.3±0.1 days. In group II the above period averaged 4.8±0.8 days (p<0.001). Absence of an intense pain syndrome in group I was caused by a gentle effect of high-frequency electric current itself on the venous wall and paravasal structures. A significant reduction of side effects and complications with a shorter stay of patients in hospital versus the traditional phlebectomy was achieved owing to reduction in the extent of injury of the surgical operation itself with the use of endovascular high-frequency welding. Conclusions: The technique of endovascular high-frequency welding in treatment of acute ascending thrombophlebitis of the great saphenous vein makes it possible to reduce the extent of injury of the surgical operation versus the traditional phlebectomy, results in a significant decrease in the number of side effects and complications and shortens the period of the patient’s stay in hospital.

scholarly journals New approach to decrease post-ERCP adverse events in patients with primary sclerosing cholangitis

2017 ◽  
Vol 05 (08) ◽  
pp. E710-E717 ◽  
Author(s):  
Udayakumar Navaneethan ◽  
Dennisdhilak Lourdusamy ◽  
Norma Gutierrez ◽  
Xiang Zhu ◽  
John Vargo ◽  
...  
Keyword(s):  
Adverse Events ◽  
Primary Sclerosing Cholangitis ◽  
Stent Placement ◽  
Sclerosing Cholangitis ◽  
Balloon Dilation ◽  
Bivariate Analysis ◽  
Contrast Injection ◽  
Group I ◽  
Increased Risk ◽  
Group Ii

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is often performed in patients with primary sclerosing cholangitis (PSC). Our aim was to validate a treatment approach with the objective of decreasing ERCP related adverse events (AEs). Patients and methods All patients who had undergone ERCP for PSC during the period from 2002 – 2012 were identified (group I). This group had traditional ERCP (no bile aspiration prior to contrast injection with balloon dilation and stent placement for treatment of dominant strictures). To decrease ERCP-related AEs, we changed the ERCP approach in which bile aspiration was performed prior to contrast injection and balloon dilation alone was performed for treatment of dominant strictures. This was tested prospectively in all patients undergoing ERCP for PSC from 2012 – 2014 (group II). Results The risk of overall AEs and cholangitis was relatively less in group II compared with group I [(2.1 % vs. 10.3 %; P = .38) and (0 % vs. 4.4 %; P = .68)]. On bivariate analysis, change in ERCP approach was associated with decreased risk of post-procedure cholangitis (0 % vs. 10.2 %, P = .03) and overall AE (0 % vs. 18.6 %, P = .03). There were no AEs in 22/46 patients in group II who had bile aspiration with balloon dilation. On multivariate analysis, only biliary stent placement was associated with increased risk of AEs (OR 4.10 (1.32 – 12.71); P = .02) and cholangitis (OR 5.43, 1.38 – 21.38; P = .02) respectively. Conclusion Biliary aspiration and avoidance of stenting approach after dilation of strictures during ERCP in PSC patients appears to be associated with decreased risk of cholangitis and overall AEs. Future prospective randomized controlled trials are needed to validate our observation.

scholarly journals Gastric proliferative lesions induced by duodenogastric reflux in rats

2006 ◽  
Vol 21 (4) ◽  
pp. 207-213 ◽  
Author(s):  
Rosângela Lucinda Rocha Monteiro ◽  
Nelson Adami Andreollo ◽  
Maria Aparecida Marchesan Rodrigues ◽  
Marina Raquel Araujo
Keyword(s):  
High Frequency ◽  
Posterior Wall ◽  
Duodenogastric Reflux ◽  
Glandular Stomach ◽  
Male Rats ◽  
Gastrojejunal Anastomosis ◽  
Adenomatous Hyperplasia ◽  
Group Iii ◽  
Group I ◽  
Group Ii

PURPOSE: To analyze mucosal proliferation and its characteristics, through specific models of duodenogastric reflux, in the stomach of Wistar rats. METHODS: Seventy-five healthy and adult male rats were divided into three groups: group I - control (n = 25 animals), submitted to gastrotomy of the posterior wall of the glandular stomach; group II - DGR (n = 25 animals), submitted to duodenogastric reflux through latero-lateral gastrojejunal anastomosis in the posterior wall of the glandular stomach and group III - DGR-P (n = 25 animals), submitted to duodenogastric reflux through the pylorus following the same procedure of group II, sectioning and closing the afferent loop. The animals were observed during 36 weeks and subsequently the mucosal lesions were analyzed, with macroscopic and microscopic examination of the prepyloric, the gastrojejunostomy and the squamous area of the stomach. RESULTS: Group I did not present any kind of lesion. Macroscopic lesions of the prepyloric area in groups II and III were 0% and 20%, respectively. Macroscopic lesions of the gastrojejunal stoma in groups II and III were 36% and 88%, respectively, and 12% and 28%, respectively, in the squamous area. Microscopically, adenomatous hyperplasia (AH), squamous hyperplasia (SH) and adenocarcinoma (AC) were diagnosed. The occurrence of AH at the prepyloric area in groups II and III was 0% and 40%, respectively, and in the gastrojejunal stoma, 40% and 72%, respectively. The occurrence of SH in the squamous area in groups II and III was 12% and 20%, respectively, without statistical differences between the groups. AC was found only in three animals of groups III (12%). CONCLUSIONS: The duodenogastric reflux in this experimental model caused high frequency of proliferative lesions of the gastrojejunal stoma and in the prepyloric area, while adenocarcinoma was a rare occurrence.

Prognostic Impact of the Presence of Barrett’s Esophagus and Intestinal Metaplasia on Esophageal Adenocarcinoma Survival

2021 ◽  
pp. 263451612110332
Author(s):  
Jennifer M. Kolb ◽  
Charlie Fox ◽  
Chloe Friedman ◽  
Frank I. Scott ◽  
Samuel Han ◽  
...  
Keyword(s):  
Overall Survival ◽  
Intestinal Metaplasia ◽  
Barrett’S Esophagus ◽  
Esophageal Adenocarcinoma ◽  
Barrett's Esophagus ◽  
Clinical Stage ◽  
Tertiary Care ◽  
Prognostic Impact ◽  
Group I ◽  
Stage 4

Background/Aims: Barrett’s esophagus (BE), defined by the presence of intestinal metaplasia (IM) on histology, is thought to be the only identifiable precursor lesion for esophageal adenocarcinoma (EAC). Recent studies have suggested the possibility of an alternate, non-IM associated EAC that is a more aggressive form of EAC with worse survival. Among EAC patients, we aimed to compare survival of patients with and without IM at the time of diagnosis. Methods: This was a retrospective cohort study of all patients with histologic confirmed EAC evaluated at a tertiary care center from 2013 to 2019. Cases were categorized according to the presence or absence of IM on histologic specimens (Group I—IM-EAC and Group II—non-IM-EAC). We compared demographic characteristics, clinical stage, therapy, and survival between the 2 groups using the Chi-square and ANOVA tests (for categorical and continuous variables, respectively). We used Cox proportional hazards regression to determine the association of IM with overall survival, adjusting for sex, age at diagnosis, tumor location, histologic grade, and clinical stage. Results: A total of 475 patients were included in this analysis (mean age 64.8 years [SD 10.8], 89% white) and 109 (23.0%) had no evidence of IM. Compared with IM-EAC (Group I), individuals in the non-IM-EAC group were younger ( P = .01) and had a greater proportion of patients diagnosed with advanced disease (49.5 vs 20.2% for stage 4, P < .001). These patients were less likely to undergo endoscopic therapy alone (0.92% vs 29.78%, P < .001) or surgery alone (0 vs 9.84%, P = .001). On multivariable analysis, the presence of IM-EAC was associated with improved overall survival compared to non-IM-EAC (HR 0.69, 95% CI 0.49-0.96). Additional factors associated with poor survival was increasing stage of diagnosis (HR 6.49: 95% CI 3.77-11.15 for stage 4, HR 2.19: 95% CI 1.25-3.84 for stage 3, HR 2.04: 95% CI 0.98-4.25 for stage 2 compared to stage 1) and more advanced histologic stage (HR 2.00, 95% CI 1.26-3.19) for poorly/undifferentiated compared to well differentiated). Conclusions: EAC without the presence of IM on histology was associated with worse survival compared to those with IM. Future prospective studies with detailed molecular sequencing are required to clarify if 2 separate phenotypes of EAC exist (IM-EAC and non-IM-EAC). If confirmed, this may have significant implications for screening and management strategies.

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