Analysis of the Effectiveness of Surgical Treatment of Benign Epithelial Esophageal Neoplasms under Control of Magnifying Chromoendoscopy

Relevance. The article presents a study and analysis of the effectiveness of the surgical treatment technique for benign epithelial neoplasms of the esophagus under the control of magnifying chromoendoscopy. Epithelial neoplasms of the esophagus and stomach are frequent diagnostic findings during endoscopic examination of the upper gastrointestinal tract. They are detected in 2% of patients, on average, during esophagogastroduodenoscopy. Notably, tactic of their management is not adequately standardized and often encounters challenges in clinical practice.

The aim of the study was to investigate the prognostic significance of individual macroscopic features that allow the morphological structure of epithelial formations to be determined during gastroscopy.

Methods. The study involved clinical data and analysis of the results of prehospital surgical interventions in patients with benign epithelial neoplasms of the esophagus, who made up the main group. Patients of the control group were exposed to endoscopic investigation and diagnosed using conventional techniques. Statistical analysis of the study results was carried out in two directions, namely: endoscopic and morphological diagnostic parameters and objective data on relapses and bleeding were compared using the nonparametric Mann-Whitney test in the main and control groups; the Spearman rank correlation coefficient was applied to assess the closeness of the statistical relationship between endoscopic diagnostic parameters and morphological criteria in order to evaluate the effectiveness of magnifying chromoendoscopy in the surgical treatment of benign epithelial neoplasms of the esophagus in patients of the main group.

Results. The use of magnifying video endoscopy provides beneficial perspectives for detailed assessment of the mucous membrane of the examined organs. Previously, chromo-endoscopy was used to identify the metaplasized epithelium, the boundaries of precancerous trasformations. However, this staining technique was quite time-consuming; it failed to determine microstructural changes in the lesion area and in the perifocal region with extreme accuracy. Currently,the use of magnifying narrow band imaging endoscopy allows visualizing the smallest changes in the tissue surface, assessing the architectonics of the vascular network in the study area and, most importantly, the prevalence of the pathological focus, which increases not only the level of diagnosis of precancerous changes, but also the effectiveness of endoscopic surgical treatment at the stage of primary health care.

In the control group, the percentage of adverse effects was 77.7% (14 cases) based on the results of 18 polypectomies of epithelial neoplasms. If compared with conventional endoscopic examination, we noted the following advantages of the narrow-band imaging endoscopy with optical magnification in the study of benign epithelial neoplasms of the esophagus: 22 cases of endoscopically detected signs of neoplastic changes in the esophageal mucosa were registered, which were morphologically confirmed in 20 patients, this amounting to 90.9%.

Conclusions. The results of the study can be useful for improving treatment approaches, developing surgical intervention protocols and making more informed clinical decisions.