RU2343839C1 - Method of diagnostics of barret esophagus - Google Patents

Abstract

FIELD: medicine; ultrasonic diagnostics.

SUBSTANCE: carry out endoscopic examination of esophagus. At discrepancy of gear line and is esophageal-gastric transition, revealing of signs of an esophagitis carry out endoscopic ultrasonography distal department of an esophagus. At revealing of focal or multifocal expansion of the second hypoechoic layer of mucosa of esophagus with its prevalence on width in comparison with the first hyperechoic layer of mucosa of aesophagus, diagnose Barret esophagus.

EFFECT: rising of accuracy of diagnostics of Barret esophagus.

2 ex, 5 dwg

Description

The invention relates to medicine, diagnostics, and specifically to methods for diagnosing Barrett's esophagus.

Known methods for the diagnosis of Barrett's esophagus by endoscopic, morphological studies and the method of chromogastroscopy [1, 2, 3, 4].

However, these methods are not accurate enough and informative.

Closest to the proposed method is a method for the diagnosis of Barrett's esophagus [1], which consists in an endoscopic examination of the abdominal esophagus and a visual determination of this disease by changing the color and structure of the mucous membrane, namely the presence of spotty erythema, alternating with whitish scars, a thinned mucous membrane with translucent vascular pattern, uneven, rough, granular structure of the mucous membrane. The main sign of Barrett's esophagus is the mismatch of the dentate line and the esophageal-gastric transition. The dentate line can rise high, almost to the level of the middle third of the esophagus. Most often, it is uneven due to the fact that the effect of thrown gastric contents is distributed unevenly around the esophagus and the mucous membrane of the esophagus is damaged in different areas unequally.

However, the known method has insufficient accuracy and informativeness, since endoscopic signs of Barrett's esophagus are weakly expressed. It is impossible to visually identify this pathology of the mucous membrane of the esophagus, since it is practically no different from the usual mucous membrane at the level of the dentate line.

The problem solved by this invention is to increase the accuracy and information content of the method.

To solve the problem in a method for the diagnosis of Barrett's esophagus by conducting endoscopic examination of the esophagus in case of mismatch of the dentate line and esophageal-gastric transition, identifying signs of esophagitis, endoscopic ultrasonography of the distal esophagus is performed and if focal or multifocal expansion of the second hypoechoic layer of the esophagus is detected in width compared with the first hyperechoic layer of the mucous membrane of the esophagus, the esophagus B is diagnosed Arreta.

In the scientific medical and patent literature analyzed by the authors, no new distinctive features were found and they do not explicitly follow the prior art for a specialist. This method has passed clinical trials at the Research Institute of Gastroenterology of the Siberian State Medical University. Thus, this technical solution meets the criteria of the invention of "novelty", "inventive step" and "industrial applicability"

The method is as follows.

Endoscopic ultrasonography is performed according to the standard principles of this ultrasound diagnostic method [5]. Standard positions for endoscopic ultrasonography for examining various organs were proposed and described in detail in 1982 by M. Sivak, W. Strohm, M. Classen and approved by the International Conference on Endoscopic Ultrasound, held in Stockholm in 1982. The study provides an opportunity to study in detail the structure the walls of the esophagus, stomach or duodenum, receiving a layered image. To study the distal esophagus, the image in standard position 7 (distal esophagus) is used.

Endoscopic ultrasonography is carried out in three successive versions (or limited to one of them): 1) by direct contact of the sensor with the mucous membrane of the esophagus, stomach or duodenum; 2) through a cylinder covering a sensor filled with distilled water to improve the resulting image of the wall of the digestive tract; 3) after the introduction through the instrument channel of the fibrogastroscope 300-400 ml of deaerated water into the stomach. The duration of the examination is 15-20 minutes.

Research is carried out in the morning on an empty stomach after night fasting. Premedication 30 minutes before the study involves intramuscular administration of 2 ml of a 0.25% droperidol solution and 2 ml of a 0.5% seduxen solution, subcutaneous administration of 1 ml of a 0.1% atropine solution and subsequent pharyngeal anesthesia with a local anesthetic (10% lidocaine solution). In some cases, drugs are introduced that suppress the motility of the digestive tract (1 mg of glucagon).

An absolute contraindication for performing the study is the patient's refusal from this manipulation. Relative contraindications are the same as for esophagogastroduodenoscopy: large goiter, deformations of the cervicothoracic spine, pronounced kyphosis (scoliosis, lordosis), stiffness of the pharynx, narrowing of the esophagus (stomach), diverticulum of the esophagus.

Endoscopic ultrasonography is started according to the standard esophagogastroduodenoscopy procedure in the patient’s position on the left side. Subsequently, if necessary, the patient can be laid on his back.

The introduction of a fibrogastroscope is performed under visual control. The fibroendoscope is promoted to the level of the distal esophagus. A miniature ultrasonic radial scanning probe MN-2R / MN-3R with a scanning frequency of 20 MHz is carried out through the instrument channel of the GIF-1T140 video fibrogastroscope, the EVIS EXERA GLV-160 video system (Olimpus, Japan) and, under visual control, is installed in the abdominal section of the esophagus. Ultrasound is performed through a cylinder filled with distilled water, covering the sensor (Figure 1). When conducting endosonography, the wall of the digestive tract is a circular structure consisting of alternating thin "rings" of increased and decreased echogenicity with clearly defined boundaries (Figure 2). At an ultrasound frequency of 20 MHz, the wall of the esophagus looks like a uniform seven-layer structure. Normally, the second hypoechoic layer looks like a thin line, the width of the second layer is less than the first hyperechoic layer (Figure 3). The use of an ultrasound probe with a frequency of 20 MHz allows you to scan the organ wall from close range and echoscopically visualize individual details, the resolution of the ultrasound probe is 0.2 mm, then endoscopic ultrasonography of the distal esophagus is performed and, if a focal or multifocal expansion of the second hypoechogenic layer of the esophagus is detected with a predominance of its width compared to the first hyperechoic layer of the mucous membrane of the esophagus, food is diagnosed Barrett waters.

The results obtained determine the multiplicity of endoscopic examination, questions of tactics of patient management, changes and additions to the therapy, the choice of surgical aid method.

The proposed criteria for the diagnosis of Barrett's esophagus by endoscopic ultrasonography are based on an analysis of the results of clinical, endoscopic observation of 35 patients with clinical, endoscopic and radiological signs of gastroesophageal reflux disease and reflux esophagitis of varying severity.

Specific examples of the method

Example 1. Patient K., 39 years old. Case history No. 2068, was admitted to the surgical department on 06/14/05 with a diagnosis of gastroesophageal reflux disease, grade III reflux esophagitis for examination, determining indications for surgical treatment and choosing the method of surgical intervention.

Esophagogastroduodenoscopy during endoscopic ultrasonography dated 06/14/05. During endoscopic examination in the lumen of the esophagus, mucus, straining, there is a reflux of gastric contents into the esophagus, in the lower third of the esophagus there are longitudinal erosion without fibrin.

Studies according to the proposed method - endoscopic ultrasonography from 06/14/05, in the distal esophagus there is a focal expansion of the second hypoechoic layer of the mucous membrane of the esophagus with a predominance in width compared to the first hyperechoic layer of the mucous membrane of the esophagus (Figure 4). A diagnosis was made of Barrett's esophagus, which was confirmed morphologically. Dysplasia was not detected.

The patient underwent laparoscopic fundoplication in a modification of the clinic. The postoperative period was uneventful.

Example 2. Patient M., 51 years old. Case history No. 3564, was admitted to the surgical department 05.12.05, with a diagnosis of gastroesophageal reflux disease, reflux esophagitis III degree. Endoscopic examination was performed on November 24, 2005 on an outpatient basis. The mucous membrane of the distal esophagus is hyperemic, swollen. The jagged line is uneven, 4 cm above the esophageal-gastric transition, from which areas of hyperemia rise in the form of “tongues of flame”. The cardia does not close tightly, when strained, the gastric mucosa proliferates into the lumen of the esophagus, gastroesophageal reflux is noted.

A study was carried out according to the proposed method - endoscopic ultrasonography from 12/08/05, in which a multi-focal expansion of the second hypoechoic layer of the esophagus mucosa with a predominance in width compared with the first hyperechoic layer of the esophagus mucosa was revealed (Figure 5). A morphological study was performed, Barrett's esophagus with mild dysplasia was diagnosed.

In the preoperative period, argon plasma coagulation of the cylindrical cell epithelium was performed with subsequent histological control. After 2 months, the patient was operated on as planned - a laparoscopic antireflux surgery was performed. The postoperative period was uneventful.

Thus, the proposed method allows more accurate diagnosis of Barrett's esophagus, does not require the use of contrast agents, is highly reliable.

BIBLIOGRAPHY

1. Godzhello E.A. Barrett's esophagus: endoscopic diagnosis, surveillance and treatment strategy // Ros. journal gastroenterol., hepatol., colonoproctol. - 2002. - No. 5. - S. 67-71.

2. Starostin B.D. Barrett's esophagus: identification, monitoring, treatment // Ros. journal gastroenterol., hepatol., colonoproctol. - 2003. - No. 3. - S.84-90.

3. Trukhmanov A.S. Barrett's esophagus: epidemiology, pathogenesis, clinical course and prevention // Ros. journal gastroenterol., hepatol., colonoproctol. - 2002. - No. 5. - S. 59-62.

4. Khadzhibaev A.M. Barrett's Esophagus // Surgery. - 2003. - No. 11. - S. 65-69.

5. Mitkov VV Clinical Guide to Ultrasound Diagnostics - M .: Vidar, 1997.

Claims (1)

A method for diagnosing Barrett's esophagus by conducting an endoscopic examination of the esophagus, characterized in that if the dentate line and the esophagus-gastric junction do not match, the signs of esophagitis are detected, endoscopic ultrasonography of the distal esophagus is performed and if a focal or multifocal expansion of the second hypoechoic layer of the esophagus is predominant the width compared with the first hyperechoic layer of the mucous membrane of the esophagus is diagnosed with Barrett's esophagus.

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