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ABSTRACT
Dysphagia is a common condition that can seriously affect a patient's quality of life. It is a common symptom in the
general population, with a prevalence of up to 20% and affecting up to 50% of people over 60 years of age. From an
anatomical point of view, it can be due to oropharyngeal or esophageal etiology, while from a pathophysiological
point of view, dysphagia can be caused by organic (benign or malignant) and functional diseases, causing mainly motor
disorders.
KEYWORDS
Anatomical point of view, etiology, functional diseases, causing mainly motor disorders.
Research Article
CLINICAL CHARACTERISTICS OF PATIENTS DURING STENTING WITH
DIFFERENT TYPES OF STENTS WITH BENIGN DYSPHAGIA
Submission Date:
May 20, 2023,
Accepted Date:
May 25, 2023,
Published Date:
May 30, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue05-09
Nizamkhodzhaev Z.M.
Republican Specialized Scientific And Practical Medical Center For Surgery Named After V. Vakhidov,
Uzbekistan
Ligay R.E.
Republican Specialized Scientific And Practical Medical Center For Surgery Named After V. Vakhidov,
Uzbekistan
Nigmatullin E.I.
Republican Specialized Scientific And Practical Medical Center For Surgery Named After V. Vakhidov,
Uzbekistan
Adkhamov Sh.A.
Republican Specialized Scientific And Practical Medical Center For Surgery Named After V. Vakhidov,
Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
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INTRODUCTION
Purpose of the study
: to determine the features of the
clinic of patients with stenting by various types of stent
with benign dysphagia
MATERIALS AND METHODS
in order to achieve the goals set by the task of studying
the features of benign dysphagia, we studied 60
patients with dysphagia syndrome caused by various
benign pathologies of the esophagus. All patients were
hospitalized at the Department of Surgery of the
Esophagus and Stomach of the State Institution
“Republican Specialized Center for Surgery named
after N.N. acad. V. Vakhidov" for the period from 2000
to 2021
The distribution of patients by sex and age is presented
in Table 1, from the data of which it follows that there
were 42 (70%) men and 18 (30%) women,
Table 1.
Distribution of patients by sex and age
Floor
19-44 years
old
45-59 years
old
60-75 years
old
75 and over
Total
Men
4
5
20
13
42 (70%)
Women
-
2
9
7
18 (30%)
Total
4 (6.67%)
7 (11.7%)
29 (48.3%)
20 (33.3%)
60 (100%)
The age of patients ranged from 19 to 78 years, the
majority were patients aged 60 to 75 years - 29 (48.3%),
The results of treatment of patients with dysphagia
syndrome, who underwent stenting of the esophagus,
were analyzed. In this regard, only those cases were
used when it was not possible to perform radical
surgical interventions due to the inoperability or
unrespectability of the process, severe alimentary
insufficiency, as well as patients who underwent
stenting of the esophagus as a preparation for surgery.
The nature of the pathologies of the esophagus, for
which stenting was performed, are presented in Table
2.
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Table 2.
Distribution of patients according to the nature of the pathology of the esophagus
Groups
Benign narrowing of the esophagus
Post-burn scar strictures
Stenosing reflux esophagitis
Main (n=27)
15 (25%)
12 (20%)
Control (n=33)
25 (41.7%)
8 (13.3%)
When analyzing the nature of the pathology of the
esophagus, he showed that benign diseases of the
esophagus are most commonpost-burn cicatricial
strictures in 40 patients (66.7%) of the total number of
patients (n=60),with a prevalence in the control group
(in 25 patients, which is 41.7%). Stenosing reflux
esophagitis prevailed in the main group, 20% versus
13.3%.
It should also be noted that due to the improvement of
instrumental methods for the treatment of benign
narrowing of the esophagus, post-burn cicatricial
strictures requiring long-term intubation of the upper
gastrointestinal tract, the number of patients has
noticeably decreased.
The clinical material was divided into 2 groups, which
were representative by gender, age, concomitant
diseases, as well as by the nature of the primary
pathology of the esophagus (p>0.05),
The first (control) group consisted of 33 patients who
underwent stenting of the esophagus and CEP with
silicone stents of our own design in the period from
2000 to 2017.
The second (main) group consisted of 27 patients who
were operated on in the period from 2018 to 2021. In
this group, a new method of stenting with metal self-
expanding stents was used, as well as an improved
complex for the prevention of postoperative
complications (Fig. 1)
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Fig 1. Distribution of patients by pathology of the esophagus and groups
Special research methods were used: endoscopy, X-ray
contrast study of the esophagus and stomach,
ultrasound, TBFS. Endoscopic examination is the
leading method in the differential diagnosis between
various diseases of the esophagus, since in most cases,
they are manifested by dysphagia (Fig. 2, 3),
Rice. 2 Endoscopic picture of cicatricial
stenosis
Rice. 3. X-ray picturecicatricial stricture of the
esophagus
0
5
10
15
20
25
Постожоговые рубцовые
стриктуры
Стенозирующий рефлюкс-
эзофагит
25
8
15
12
Контрольная группа
Основная группа
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RESULTS AND DISCUSSIONS
among the stenosing diseases of benign origin,
characterized by the formation of cicatricial stricture,
are post-burn cicatricial strictures of the esophagus
and stenosing reflux esophagitis. In both cases, the
formation of cicatricial stricture is due to the influence
of a chemical reagent on the mucous membrane of the
esophagus. However, if in the case of SRE, the stricture
is formed only in the lower third of the esophagus, then
in PRSP it can form in any anatomical segment of the
esophagus. Stenting for benign stenoses is used when
other minimally invasive interventions, such as
bougienage and hydroballoon dilatation, are not
effective, i.e. give a short-term effect.
As with a malignant lesion, the stricture prevents
adequate passage of food through the esophagus and
causes a key symptom, dysphagia. In our study, all 60
patients underwent stenting with PRSP and SRE. Of
these, the control group consisted of 33 patients,
which accounted for 55% and 27 (45%) patients of the
main group.
The distribution of patients according to the duration
of the disease was as follows: 4-6 months in 12 (20%)
patients, 6-12 months in 1 (1.7%) patient, over 1 year in
47 (78.3%) patients (Table 3 .),
Table 3
Distribution of patients according to the duration of the disease
Groups
Disease duration
4
-6 months
from 6
mo
nths
t
o 1
ye
ar
over
1 y
ear
Total
Main
5
-
22
27 (45%)
Control
7
1
25
33 (55%)
Total
12 (20%)
1 (1.7%)
47 (78.3%)
60 (100%)
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The distribution of patients according to the degree of
dysphagia in the comparison groups was as follows: I
degree of dysphagia was observed in 4 (6.7%) patients,
II degree in 23 (38.3%) patients, III degree in 27 (45%)
patients and IV degree in 6 (10%) patients.
The distribution of patients depending on the degree
of dysphagia is presented in Table 4.
Table 4
Distribution of patients according to the degree of dysphagia
Groups
Degree of dysphagia
I
II
III
IV
Total
Main
2
eleven
12
2
27 (45%)
Control
2
12
15
4
33 (55%)
Total
4 (6.7%)
23 (38.3%)
27 (45%)
6 (10%)
60 (100%)
As follows from the table, I degree of dysphagia, both
in the CG and in the MG, was observed in 2 patients. II
degree, in the CG was observed in 11 patients, and in
the OG in 12 patients. III degree of dysphagia, in the CG
was noted in 12 patients and in 15 patients in the MG. IV
degree of dysphagia, in the CG was observed in 2
patients and in 4 patients in the MG.
The distribution of patients according to the location
of cicatricial strictures is presented in Table 5.
Table 5
Localization of cicatricial strictures
Groups
Localization
Total
c/3
s and n/3
n/3
n/3 and
CEP
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Main
3
3
9
12
27 (45%)
Control
4
6
15
8
33 (55%)
Total
7 (11.7%)
9
(15%)
24 (40%)
20 (33.3%)
60
(100%)
It follows from the table data that strictures were
localized in the middle third of the thoracic esophagus
in 7 (11.7%) patients, in the middle and lower third of the
thoracic esophagus - 9 (15%), in the lower third of the
thoracic esophagus - 24 (40%) and localization tumors
in zone n/3 and cardioesophageal junction in 20
patients, which was 33.3%.
Also, as in the case of tumor stenoses, the
determination of the length of the cicatricial stricture
was important, since the choice of the stent length
depended on it. During the examination, we
established the following length: from 4 to 6 cm, from
7 to 9 cm, and the longest from 10 to 12 cm. The
distribution of patients according to the length of the
stricture is presented in Table 6.
Table 6
Distribution of patients according to the length of cicatricial strictures
Groups
length of cicatricial strictures
Total
4-6 cm
7-9 cm
10-12 cm
Main
17
5
5
27 (45%)
Control
17
8
8
33 (55%)
Total
34 (56.7%)
13 (26.6%)
13 (26.6%)
60
(100%)
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As follows from the table, the length from 4 to 6 cm
prevailed in 34 (56.7%) patients. And in the rest of the
patients, the length of cicatricial strictures was almost
the same: from 7 to 9 cm in 13 (26.6%) patients and in 13
(26.6%) patients, the length was from 10 to 12 cm.
Stenting of benign strictures with silicone stents: In the
department of surgery of the esophagus and stomach,
together with the department of endoscopy of the
State Institution "RSCS named after academician V.
Vakhidov", in 2002, an own method of endoscopic
stenting (ES) of the esophagus in patients with PRSP
was developed and put into practice.
An improved prosthesis model was used for
endoscopic stenting. The length and diameter of the
stent were selected strictly individually in accordance
with the length and diameter of the narrowing of the
esophagus.
In the control group, stenting of the esophagus with
silicone rigid endoprostheses of our own design, in
case of benign stenosis, has a number of limitations.
The limited use of ES is due to the fact that careful
selection of patients is necessary to obtain optimal
results. This technique is possible under certain
conditions that allow the use of ES.
For our studies, we considered contraindications to
endoscopic stenting:
1. Ulcerative necrotic esophagitis in the early post-burn
period. As is known, in the first 3 months, the stricture
of the esophagus only begins to form, while in most
cases the phenomena of ulcerative necrotic
esophagitis persist. The use of stenting in this situation
can lead to pressure ulcers of the wall and bleeding. In
this regard, in the first 3 months, it is necessary to
conduct complex local therapy, which will contribute
to adequate healing of the esophageal wall.
2. Absence of suprastenotic expansion of the
esophagus over the narrowing. Compared to standard
mesh implants that grow through connective tissue
and remain permanently in the lumen of the
esophagus, our stent models are made of silicone that
can migrate distally under gravity. Therefore, for
adequate fixation of the prosthesis, it is necessary to
have a suprastenotic expansion above the stricture,
where an anti-migration funnel can be fixed.
3. Cicatricial narrowing of the esophagus with the
capture of the pharynx or mouth of the esophagus.
This contraindication is due to the need to fix the
endoprosthesis, which cannot be provided in the oral
cavity or in the pharynx.
4. Total post-burn cicatricial narrowing of the
esophagus. In most cases, with total strictures, it is
impossible to perform stenting, because. before
installing the prosthesis, it is necessary to adequately
expand the stricture by bougienage. In exceptional
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cases, stenting can be performed in these patients for
preoperative preparation.
Rice. 4. X-ray picture before and after endoscopic stenting
The installation of a stent of our own design requires a phased expansion of the esophagus by bougienage along the
string, EB replaceable olives and HD. At the same time, for the adequacy and safety of further ES, it is necessary to
expand the stricture to 1.2-1.4 cm, which corresponds to bougie No. 38-40 (Figure 4.5.).
A) Stenosing reflux esophagitis
B) After stenting
(no contrast)
B) After stenting
(with contrast)
Rice. 5. X-ray picture before and after endoscopic stenting
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After restoring the patency of the esophageal
stricture, control endoscopy is performed, during
which the length of the future stent is accurately
determined, as well as the distance of the stricture
from the mouth of the esophagus (Fig. 4.5.).
The stenting technique in the control group was
carried out according to the described methods: on a
bougie and on an endoscope device and was
performed in 33 (55%) patients. As in case of tumor
stenoses, after stenting, the stent localization was
monitored (Figure 4.5.).
Results of stenting for benign strictures. Stenting of
benign strictures with metal stents: In the main group,
stenting was also performed according to the method
described above. However, it should be noted that
stenting with self-expanding stents often did not
require preliminary bougienage, since the introducer
itself acted as a bougie. In the main group, stenting for
benign strictures was performed in 27 patients, which
accounted for 45%. After stenting, as well as in the
control group, a mandatory control of the localization
of the installed stent was carried out (Fig. 5.)
When evaluating the results of stenting of 60 patients
with PRSP and ESR, we, as in the case of a tumor lesion,
evaluated both immediate and long-term results.
When evaluating the immediate results (Table 7.), it
was found that, in the control group, out of 33 patients
who used stents of their own design, all 100% had
various complications. In the main group, out of 27
patients who used self-expanding nitinol stents,
complications were not observed in 17 patients, which
amounted to 63%.
Table 7
Immediate results of stenting
The nature of the complications
Silicone
stents
n=33
Metal nitinol
stents
n=27
Bleeding
4 (12%)
1 (3.7%)
Damage to the wall of the esophagus without
perforation
5 (15.2%)
1 (3.7%)
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Intractable pain syndrome
11 (33.3%)
2 (7.4%)
Reflux esophagitis
13 (39.4%)
3 (11.1%)
Total:
33 (100%)
7 (26%)
As follows from the table, in the control group, the
number of complications exceeds the number of
stents performed. This is due to the fact that one
patient had one or more complications. In the main
group, complications developed in 7 patients, which
amounted to 26%.
In the structural analysis of the complications that have
arisen, we found that non-penetrating damage to the
esophageal wall in the control group was noted in 4
(12.1%) patients, while in the main group, this type of
complication was observed in 1 patient, which
amounted to 3.7 %. Intractable pain syndrome caused
by the pressure of the stent on the cicatricial stricture
was observed in 11 patients in the control group, which
amounted to 33.3%, and in the main group in 2 patients
and amounted to 7.4%. Bleeding in the control group
was observed in 4 (12.1%) patients, in the main group in
1 (3.7%) patients. Reflux esophagitis, in the CG was
observed in 14 (42.4%) patients, and in the main group,
a decrease in this indicator was noted in 3 patients,
which amounted to 11.1%.
Long-term results were evaluated at 1 month, 6
months and 1 year. Complications in the control group,
in the long-term period were observed in 20 (60.6%)
patients, in the main group this figure decreased and
amounted to 18.5% (Table 8.)
Table 8
Distribution of patients by late complications
Late Complications
Silicone
stents
(n=33)
Metal nitinol
stents
(n=27)
Reflux esophagitis
6 (18.2%)
1 (3.7%)
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Food obturation of the stent
5 (15.1%)
3 (11.1%)
Obturation of the proximal stent by cicatricial
(granulation) process
3 (9.09%)
1 (3.7%)
Migration of the stent into the stomach and small intestine
6 (18.2%)
-
Total:
20 (60.6%)
5 (18.5%)
Among the late complications, as follows from the
table, reflux esophagitis was the most common. The
latter was diagnosed in 6 (18.2%) patients in the control
group; in the main group, due to the antireflux
mechanism, this indicator decreased and was observed
in 1 (3.7%) patients. Obturation of the proximal stent
funnel with food in the control group was observed in
5 (15.2%) patients, and in the main group in 3 (11.1%)
patients. Obturation of the proximal stent by the
granulation process in the control group was noted in
3 (9.1%) patients, and in the main group this indicator
decreased and was observed in 1 (3.7%) patient. Stent
migration into the stomach or small intestines of the
control group was observed in 6 (18.2%) patients, while
in the main group this type of complications was not
noted.
Thus, Based on our research, we can conclude that
among benign diseases of the esophagus, the most
commonpost-burn cicatricial strictures (n=40) in 66.7%
of the total number of patients (n=60),It should also be
noted that due to the improvement of instrumental
methods for the treatment of benign narrowing of the
esophagus, post-burn cicatricial strictures, the number
of patients requiring long-term intubation of the upper
gastrointestinal tract has noticeably decreased.
When evaluating the results of stenting of 60 patients
with PRSP and ESR, we, as in the case of a tumor lesion,
evaluated both immediate and long-term results.
When evaluating the immediate results, it was found
that, in the control group, out of 33 patients who used
stents of their own design, all 100% had various
complications. In the main group, out of 27 patients
who used self-expanding nitinol stents, complications
were not observed in 17 patients, which amounted to
63%.
REFERENCES
1.
Dengina NV Modern therapeutic possibilities
for esophageal cancer (In Russian) // Practical
Oncology. - 2012. Vol.13, No 4. - P. 47 - 56.
Volume 03 Issue 05-2023
65
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
05
P
AGES
:
53-66
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
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Servi
2.
Cools-Lartigue J, Jones D, Spicer J, Zourikian T,
Rousseau M, Eckert E, et al. Management of
dysphagia in esophageal adenocarcinoma
patients
undergoing
neoadjuvant
chemotherapy: can invasive tube feeding be
avoided? Ann Surg Oncol 2015; 22: 1858
–
65. doi:
https://doi.org/10.1245/s 10434-014-4270-9.
3.
Waddell T, Verheij M, Allum W, Cunningham D,
Cervantes A, Arnold D. European Society for
Medical Oncology (ESMO) European Society of
Surgical Oncology (ESSO) European Society of
Radiotherapy and Oncology (ESTRO) Gastric
cancer: ESMO-ESSO- ESTRO Clinical Practice
Guidelines for diagnosis, treatment and follow-
up. Ann Oncol 2013; 24 (Suppl 6): vi57
–
vi63. doi:
https://doi.org/10.1093/annonc/mdt344.
4.
Park JH, Song HY, Kim JH, Jung HY, Kim JH, Kim
SB, Lee H, et al. Polytetrafluoroethylene-
covered retrievable expandable nitinol stents
for malignant esophageal obstructions: factors
influencing the outcome of 270 patients. AJR
Am J Roentgenol 2012; 199: 1380
–
6. doi:
https://doi.org/10. 2214/AJR. 10.6306.
5.
Na HK, Song HY, Kim JH, Park JH, Kang MK, Lee
J, et al. [8] How to design the optimal self-
expandable oesophageal metallic stents: 22
years of experience in 645 patients / J Surg
Oncol
2012;
105:60
–
5.
doi:https://doi.org/10.1002/js o.22059.
6.
Doosti-Irani A, Mansournia MA, Rahimi-
Foroushani A, Haddad P, Holakouie-Naieni K.
Complications of stent placement in patients
with esophageal cancer: A systematic with
malignant strictures. // Eur Radiol 2013; 23:786
–
96. doi: https://doi.org/10.1007/s00330-012-
2661-5.
7.
Park JH, Song HY, Shin JH, Cho YC, Kim JH, Kim
SH, et al. Migration of retrievable expandable
metallic stents inserted for malignant
esophageal
strictures:
incidence,
management, and prognostic factors in 332
patients. AJR Am J Roentgenol 2015; 204:1109
–
14. doi: https://doi.org/10.2214/AJR.14.13 172.
8.
Battersby NJ, Bonney GK, Subar D, Talbot L,
Decadt B, Lynch N. Outcomes following
oesophageal stent insertion for palliation of
malignant strictures: A large single center
series. // Copyright © 2022 The Author(s).
Published by Scientific & Academic Publishing
review and network meta-analysis. PLoS One
2017;
12:
e0184784.
doi:https://doi.org/10.1371/journal.pone.018478
4.
9.
Wagh MS, Forsmark CE, Chauhan S, Draganov
PV. Efficacy and safety of a fully covered
esophageal stent: a prospective study.
Gastrointest Endosc 2012; 75:678
–
82. doi:
https://doi.org/10.1016j.gie. 2011. 10.006.
Volume 03 Issue 05-2023
66
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
05
P
AGES
:
53-66
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
10.
Stahl M, Mariette C, Haustermans K, Cervantes
A, Arnold D. ESMO Guidelines Working Group
Oesophageal cancer: ESMO Clinical Practice
Guidelines for diagnosis, treatment and follow-
up. Ann Oncol 2017; 24 (Suppl 6): vi51
–
vi56. doi:
https://doi. org/10.1093/annonc/mdt342.
