Aims-the objective of the present article was to describe the methodology of high-resolution esophageal manometry and analysis of its results in the context of their conformity with the requirements of the modern internationally accepted guidelines. Another objective was to demonstrate the clinical significance of investigations into the motor function of the oesophagus for making the diagnosis of oesophageal disorders, their differential diagnostics, and the choice of the adequate treatment strategies in the patients presenting with these conditions. Basic premises. Pathogenesis of many oesophageal problems is associated with the disturbances of the motor function of the thoracic oesophagus and/or the lower oesophageal sphincter (LES). High-resolution esophageal manometry makes it possible to measure resting pressure at the level of the upper and lower oesophageal sphincters, to estimate the degree of their opening in response to swallowing, to evaluate the force of muscular contraction in the thoracic oesophagus, to determine the location of the upper and lower oesophageal sphincters (i.e. their distance from the nostrils) as well as the total length of the oesophagus. Moreover, high-resolution manometry permits to detect the gastroesophageal hernia and determine its size, reveal spastic contractions, estimate the effectiveness of esophageal motility, and discover a barrier preventing the bolus passage at the level of sphincters. The evaluation of changes in oesophageal motility is of primary importance for differential diagnostics in the patients suffering from dysphagia and non-coronarogenic chest pain, achalasia cardiae, other organic and functional diseases of the oesopahgus as well as for taking decision as regards the necessity of endoscopic or surgical intervention for the treatment of gastroesophageal reflux diseases and achalasia cardiae. Conclusion. High-resolution esophageal manometry should be recommended for the management of the patients presenting with the clinical symptoms suggesting possible disturbances of the motor function in the thoracic oesophagus (such as dysphagia retrosternal pain, regurgitation, and belching). Of special importance is the evaluation of the motor function of the oesophagus for taking the final decision as regards the necessity of endoscopic or surgical intervention for the treatment of gastroesophageal reflux diseases and achalasia cardiae. At present, high-resolution esophageal manometry is considered to be «the golden standard» in diagnotsics of the disturbances in the motor function of the oesophagus.
Aim. A clinical demonstration of the feasibility of novel superpulsed thulium fibre laser in contact intraductal lithotripsy in patients with choledocholithiasis and pancreatic lithiasis.Key points. We describe two clinically successful ablations of large biliary and pancreatic calculi using a FiberLase U2 superpulse fibre thulium laser appliance (IRE-Polus, Russia) during oral transpapillary cholangiopancreaticoscopy in patients with technically unfeasible conventional minimally invasive treatment for choledocho- and pancreatic lithiasis. A 72-yo patient was urgently admitted with acute mechanical jaundice, cholangitis and a history of endoscopic papillosphincterotomy (EPST) and bilioduodenal stenting with a plastic implant for technically impractical lithotripsy and lithoextraction. An ineffective extracorporeal lithotripsy attempt was followed on day 3 by a second retrograde intervention and endoscopic contact laser lithotripsy controlled in oral transpapillary cholangioscopy with FiberLase U2. A 50-yo patient was admitted with clinical signs of chronic calculous pancreatitis and a history of EPST, pancreatic ductotomy and plastic pancreatic stenting. The first endoscopy stage comprised the encrusted pancreatic stent removal, retrograde pancreaticography, pancreatic ductotomy, narrowed terminal Wirsung’s duct bougienage with mechanical dilators and additional balloon-assisted dilation of the excision area and pancreatic stricture. Mechanical intraductal lithotripsy was unsuccessful. Contact lithotripsy with a novel superpulsed fibre thulium laser has been rendered. The technique presented ensures a complete sanation of the duct at no mucosal damage.Conclusion. We present the fully successful first national and world experience of the superpulsed fibre thulium laser application in contact lithotripsy of large calculi in common bile and main pancreatic ducts.
Diagnosis of intestinal obstruction was not confirmed in 15 (25.9%) patients based laparoscopic checkup. Acute early adhesive intestinal obstruction was established in 43 (74.1%) patients. Small intestine injuries were observed in 2 (4.5%) cases during laparoscopy. Contraindications to laparoscopic treatment of obstruction were determined in 18 (41.9%) patients in whom conventional operations were performed with complications and death in 7 (38.8%) and 3 (16.6%) cases respectively. Curative laparoscopy was applied in 23 (53.4%) patients with successful resolving of intestinal obstruction and complications in 19 (82.7%) and 4 (17.4%) cases respectively.
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