THE RESULTS OF MULTIMODAL SURGICAL TREATMENT OF PATIENTS WITH COLUMNAR EPITHELIAL METAPLASIA OF THE ESOPHAGEAL MUCOSA

Abstract

Objectives. The clinical-paraclinical aspects that determine the evolution of columnar epithelial metaplasia of esophageal mucosa and the results of its treatment, currently represent divergences in defining the notion of metaplased columnar esophagus with subsequent deficiencies in diagnostic-curative management, forms of screening and supervision of patients, as well as minimally invasive therapeutic options. The aim of the study was to assess the results of multimodal surgical treatment in patients with metaplased columnar esophagus, by implementing contemporary methods of surgical treatment: endoluminal and laparoscopic. Materials and methods. This material is a prospective, cohort clinical study conducted during 2015-2019 years with statistical evaluation (Likelihood Ratio test, Chi Square test, Pearson's chi-square test) of the results of multimodal treatment in 61 patients with chronic forms of evolution of gastroesophageal reflux disease, complicated by metaplased columnar esophagus. Results and discussions. The applied treatment was staged: drug (proton pump inhibitors (Esomeprazole 40mg tablets or Omeprazole 40mg tablets), Maalox (Takeda Pharmaceutical, România) suspension, prokinetics (Doprokin (10 mg, World Medicine, Turkey) or Motilium (10mg, S.C. Terapia S.A. Romania) tablets) for a period of 30 days (in two stages: preoperative, and postoperative for 45 days), endoluminal (4 endoscopic mucosal dissections, 22 endoscopic submucosal resections and 35 Argon-Plasma coagulation procedures) and laparoscopic (6 Hill-Toupet interventions, 24 - Hill-Nissen-Rossetti, 31 - Hill-Lortat-Jacob). Complete remission of esophageal metaplasia and gastroesophageal reflux, by the applied treatment, was detected in 58 patients with metaplased columnar esophagus, in 1 patient there were islands of metaplasia at the control examination after 1 month, and 2 patients had presented recurrences of metaplasia to varying degrees at 1 year of age. In about 1% there were postendoluminal postoperative complications (postinterventional stenosis and remaining islands of metaplasia), and about 2% of patients had complications in the surgical stage. Conclusion. The treatment of metaplased columnar esophagus requires interdisciplinary cooperation (endoscopist, histopathologist and surgeon), with the application, in a timely manner, of the possibilities of endoluminal excision in the first step and antireflux surgical treatment in the subsequent stage.

Keywords

• esophageal metaplasia
• gastroesophageal reflux disease
• endoluminal treatment
• antireflux treatment