Endoscopic diagnosis and treatment of esophageal diseases

Abstract

Introduction: Non-neoplastic disorders of the esophagus amount 89-92% of all diseases of the esophagus, these include various esophagitis, diverticula of different localization, stricture of the esophagus and esophageal motility disorders (Mozheiko M.A. et al. 2018). Esophageal neoplasms are divided into benign (5%) and malignant (95%). Aim: Demonstrate the possibilities of endoscopy in the diagnosis and treatment of esophageal disorders. Materials and methods: Modern endoscopic diagnostics includes examination not only in white light, but also light and electronic filters that are used to improve the image and examine the vascular pattern (NBI, ISCAN). If necessary, the study can be supplemented with chromoscopy (Lugol's solution, 1% - acetic acid), which will allow to detailed assessment of the mucosal surface and identify pathological lesions. During the esophagoscopy, it is possible to take material for cytological or histological examination, which is necessary for making a diagnosis. Treatment options for Barrett's esophagus include: argon plasma ablation, resection of foci or radiofrequency ablation. Endoscopic antireflux mucosectomy of the cardiac mucosa is possible at cardiac insufficiency. Benign mucosal neoplasms are possible to remove using loop resection, cap resection of the formation or dissection in the submucosal layer. The first stage with malignant neoplasms is performed EUS to assess the degree of invasion, as well as the presence of regional lymphadenopathy. T1aN0M0 cancer is dissected in the submucosal layer, intraluminal photodynamic therapy is also possible. Neoplasms in the submucosal layer are used submucosal tunneling resection techniques. Achalasia cardia are treated with using dilatation or oral myotomy. Zenker's diverticulum are treated with using diverticuloesophagostomy, and also there is tunneling resection techniques that can be possible. Results: In Oncology Dispensary of Leningrad Regional since 2016 RFA was performed for 27 patients with Barrett's esophagus with dysplasia of various degrees. Endoscopic antireflux mucosectomy of the cardiac mucosa was performed in 4 patients. Conclusions: Endoscopic resection of the esophageal mucosa lesions are performed in 45-50 patients annually. Endoscopic submucosal dissection of esophageal cancer are performed 10-15 patients annually. Submucosal tunneling resection techniques performed 4-5 patients per year.