Kosenko P.M., Vavrinchuk S.A. Possibilities for Pyloroduodenal Stenosis Diagnostics after Sealing of Perforated Duodenal Ulcer // United European Gastroenterology Journal – October 2015: Vol.3(5S). P. A581, P1495.
Possibilities for Pyloroduodenal Stenosis Diagnostics after Sealing of Perforated Duodenal Ulcer
P. M. Kosenko1, S. A. Vavrinchuk1
Contact E-mail Address: kosenko @ inbox.ru
Introduction: Disorders of gastric and duodenal motility are present in 10.0- 56.3% of patients with ulcer and in up to 65% cases after its surgical treatment, which makes the issue of timely diagnostics and prevention of post-operational motility disorders very actual.
Aims & Methods: Aims. Improvement of early diagnostics of motor-evacuator disorders after organ-preserving operations on perforated duodenal ulcer (PDU).
Methods: Study subject - 227 patients with PDU operated in the period from 2008 till 2013. First group consisted of 189 (83.2%) patients after PDU sealing and second group consisted of 38 patients (16.7%), who underwent duodenoplasty. Control group consisted of 54 healthy volunteers.
Study method involved peripheral electrogastroenterography (PEGEG) using apparatus Gastroscan-GEM in accordance with the standard method. Statistical processing involved discriminatory analysis (DA) of PEGEG parameters with creation of mathematical models on its base. For automated screening diagnostics of electrophysiological signs of PDS and determination of the degree of its compensation on the basis of the created PDS mathematical model we used original computer software ‘‘System for Decision Making Support in Determination of the Degree of Pyloroduodenal Stenosis Compensation’’.
Results: In the 1st group in 63.4% of cases the patients after sealing the PDU were classified into the group of subcompensated PDS, which was caused by the presence of stenosis in the PU sealing area with the disrupted peristalsis activity and initial signs of decompensated gastric motorics.
Post-operational radiological and endoscopic studies have confirmed the presence of the changes typical for the subcompensated stenosis in form of the narrowing of duodenum and enlargement of the stomach (27%), presence of moderate amount of liquid in fasting state (34%) and deformity of duodenal bulb (69.2%).
Signs of severe gastric stasis in this group of the patients manifested in 15.4% of patients and signs of moderately severe gastric stasis manifested in 23.1% of patients.
The performance of intraduodenal revision significantly increased the number of detected combined ulcerative complications and lesions. For example, in 2nd group of the patients pyloroduodenal stenosis was detected during the surgery in 26.3% of cases, ‘‘mirror’’ and circular ulcers of duodenum were detected in 18.4% of cases.
After duodenoplasty with correction of stenosis detected during the operation in 26.3% of cases we noted completely opposite distribution of patients with compensated type of motorics of stomach and other gastrointestinal sections with physiological response to stimulation and timely or residual accelerated evacuation of food stimulant from the stomach into the duodenum. This group of patients did not have any clinical manifestations of stenosis and needed no repeated surgical interventions due to stenosis.
Conclusion: The software ‘‘System for Decision Making Support in Determination of the Degree of Pyloroduodenal Stenosis Compensation’’ created on the basis of DA of PEGEG parameters and their mathematical models allows us to perform the automated computer screening diagnostics of PDS and to determine the degree of its compensation.
Disclosure of Interest: None declared
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