Morpho–functional monitoring of the esophagus status as the base for the dispenser observation in the patients with achalasia of cardia after surgical esophagocardiomyotomy

Abstract

Objective. To improve the early diagnosis of complications, occurring after esophagocardiomyotomy in the patients, suffering achalasia of cardia, and their correction, using the early dispenser examination, which have included endoscopic and timed roentgenographic esophageal investigations. Materials and methods. From 1972 to 2008 yr in the Institute of Surgery and Transplantology named after O. O. Shalimov NAMS of Ukraine of 568 patients with achalasia of cardia of all four degrees, except the cases of advanced dolihomegaesophagus, 389 (68.5%) the dispenser observation with the monitoring endoscopy and timed roentgenography of the esophagus were conducted. The patients were distributed into two Groups: Group I - 188 (48.3%) patients, to whom during the first seven postoperative years the yearly recommended elective examination was conducted, and Group II – 201 (51.7%) patients, to whom during the same period of time the recommended examination was performed 2 or 3 times only. Results. In total, in only 16 (8.5%) patients of the Group I it was necessary to conduct the conservative correcting treatment course, which have consisted of pneumocardiodilatation, while in the Group II such a treatment became necessary in 25 (12.4%) patients, and in particular, 16 – twice and 9 – three times, so in Group II 59 (29.4%) such courses were performed. Thus, in Group II the need for conduction of the correcting treatment courses was more, than in the Group I, what was confirmed by the patients' quantity, who needed such a treatment (the tendency was established only), and by the quantity of the courses completed (with statistically significant difference). The benefit from application of the proposed program for dispenser observation was in constant multi-year prolongation of the operation treatment potential and in correcting organ-preserving procedures as well. Conclusion. The proposed procedure of morpho-functional esophagological monitoring in the program of early dispenser examination in the patients with achalasia of cardia after esophagocardiomyotomy performance is based on data of chromoendoscopy with biopsy and timed esophagography about obstructive, reflux and preneoplastic esophageal changes, and guarantees a timely diagnosis of operative complications and the disease recurrence.