Heterotopia of gastric mucosa and long segmental Barrett’ oesophagus complicated by cicatricial stricture of the upper third of the oesophagus

A 26-year-old patient with no symptoms of gastroesophageal reflux disease developed complaints of dysphagia. Endoscopic examination revealed a short grade 3 cicatricial stricture in the upper third of the oesophagus, and in the lower parts of the oesophagus mucosa was represented by a columnar epithelium for 16 cm. Histological examination verified the long segmental Barrett’ oesophagus. Above the stricture large areas of heterotopia of the gastric mucosa were determined among the regular oesophageal squamous epithelium. While taking proton pump inhibitors, the patient underwent a long course of endoscopic bougienage with intramural dexamethasone injections, which made it possible to stabilize the lumen in the stricture zone at a level of 12 mm. A precise examination of all parts of the oesophagus with the use of modern clarifying imaging techniques allows to correctly interpret the endoscopic picture and determine the further tactics of treatment and follow-up, taking into account the possible risks of neoplasia in the heterotoped area of the mucosa of the upper third of the oesophagus.

HEMOSTATIC AND RHEOLOGICAL DISORDERS IN PATIENTS WITH OBSTRUCTIVE JAUNDICE WITH CHOLESTASIS SYNDROME

Одной из наиболее тяжелых патологий гепатопанкреатодуоденальной зоны являются диффузные заболевания печени: хронический гепатит (ХГ) и цирроз печени (ЦП), которые часто являются неблагоприятным осложнением обструктивной желтухи. В последнее время наблюдается тенденция к увеличению обструктивной желтухи некалькулезного происхождения; стеноз (БДС) большого двенадцатиперстного сосочка 1629%; панкреатит 5,427,4%, стриктура рубцов внепеченочного желчного тракта 5. 315%, паразитарные заболевания печени 1,64%; уровень гомеостаза и реологических нарушений зависит от продолжительности холестаза, что способствует развитию цитологических процессов в печени и увеличению печеночной недостаточности. Выявление скрытых механизмов печеночноренальной недостаточности в обструктивной желтухе в различные периоды холестаза имеет большое значение для своевременной диагностики и активной предоперационной коррекции и после хирургического лечения данной патологии с целью снижения операционного риска и послеоперационной летальности. One of the most severe pathologies of the hepatopancreatoduodenal zone is diffuse liver diseases: chronic hepatitis (CG) and cirrhosis of the liver (LC), which are often an unfavorable complication of obstructive jaundice. Recently, there has been a tendency to an increase in obstructive jaundice of noncalculous origin; stenosis (BDS) of the large duodenal papilla 16- 29%; pancreatitis 5.4-27.4%, cicatricial stricture of the extrahepatic biliary tract 5.3-15%, parasitic liver diseases 1.6-4%.The level of homeostasis and rheological disorders depends on the duration of cholestasis, which contributes to the development of cytological processes in the liver and an increase in liver failure. Revealing the hidden mechanisms of hepatic-renal insufficiency in obstructive jaundice at different periods of cholestasis is of great importance for timely diagnosis and active preoperative correction and after surgical treatment of this pathology, in order to reduce the operational risk and after the operational lethality

Risk factor analyses of severe cicatricial stricture after chemoradiotherapy for stage II/III (T3) esophageal carcinoma.

190 Background: Severe benign cicatricial stricture (SBCS) is a major complication after chemoradiotherapy (CRT) for esophageal carcinoma (EC), and causes oral intake impairment leading to deterioration of quality of life even after being cured. Aim of this study was to investigate risk factors of SBCS. Methods: The subjects of this study were patients with stage II/III (T3) EC who received CRT and achieved complete response (CR) between 2000 and 2011. SBCS was determined as disability of passage by diameter-9mm endoscope. Results: Among 197 patients with Stage II/III (T3) treated by CRT, CR was obtained in 91 patients, who were included in this analysis. The median age was 63 years. Fifteen patients (16.5%) were female. The median follow-up time was 5.1 years. The cumulative incidence of SBCS was 15.0% (95%CI 9.0-24.5). Significant risk factors of SBCS were female (hazard ratio (HR) 3.3 (95%CI 1.1-10.0), p = 0.04), requirement of diced/liquid meal (HR 5.7 (95%CI 1.8-18.2), p = 0.003), tumor occupying 3/4 or grater of esophageal perimeter (HR 7.4 (95%CI 1.3-42.9), p = 0.03) and disability of endoscope passage (HR 12.7 (95%CI 4.2-38.5), p < 0.001) in univariate analysis. Hypoalbuminemia increased the risk of SBCS (HR 2.4 (95%CI 0.8-7.1), p = 0.12) marginally. As for the factors during CRT, grade 2-4 esophagitis significantly increased the risk of SBCS (HR 6.2 (95%CI 1.5-25.7), p = 0.01). Multivariate analysis showed that hypoalbuminemia (HR 3.5 (95%CI 1.1-11.1), p = 0.03) and disability of endoscope passage (HR 14.8 (95%CI 4.3-51.3), p < 0.001) were the significant risk factors of SBCS. Female (HR 1.5 (95%CI 0.5-4.9), p = 0.51) was not a significant risk factor in multivariate analysis. Conclusions: Obstructions before CRT, hypoalbuminemia and severe esophagitis during CRT are considered as risk factors of SBCS. Because SBCS occurred after completion of CRT, prophylactic treatment should be established especially for esophageal carcinoma patients with risk factors of SBCS.

Mucosal wound and cicatricial stricture formation in the dog trachea: an experimental study

Complete healing of full-thickness tracheal mucosal wounds of different sizes was studied in three groups of dogs. No stricture was observed when the mucosal wounds were less than 20×15 mm. Obvious stricture, however, occurred when the wounds were 20×25 mm. Normal epithelium regenerated on the wounded areas in all of the three groups within seven weeks.