Endoscopy 2019; 51(04): S238-S239
DOI: 10.1055/s-0039-1681886
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Esophagus ePosters
Georg Thieme Verlag KG Stuttgart · New York

DIAGNOSIS AND TREATMENT OF PATIENTS SUFFERING FROM AUTOIMMUNE DISEASES OF THE ESOPHAGUS, COMPLICATED BY BENIGH STRICTURE

M Korolev
1   Saint Petersbug State Pediatric Medical University, Saint Petersburg, Russian Federation
,
L Fedotov
1   Saint Petersbug State Pediatric Medical University, Saint Petersburg, Russian Federation
,
A Ogloblin
1   Saint Petersbug State Pediatric Medical University, Saint Petersburg, Russian Federation
,
B Fedotov
1   Saint Petersbug State Pediatric Medical University, Saint Petersburg, Russian Federation
,
D Luchinina
1   Saint Petersbug State Pediatric Medical University, Saint Petersburg, Russian Federation
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Identification of the clinical features, diagnosis and treatment of 4 nosological units: mucous membrane pemphigoid (MMP), lichen planus (LP), eosinophilic esophagitis (EoE) and Crohn's disease (CD).

Methods:

From 2003 to 2017, 57 patients with esophageal strictures caused by autoimmune diseases were treated. EoE – 24 cases (42%), LP – 15 (26%), CD – 10 (18%), and RP – 8 (14%) patients. An Rg-contrast study revealed that in most cases MMP and LP were complicated by the stricture of the proximal esophagus, EoE and CD were complicated by the strictures of the distal esophagus, and in 7 patients with EoE the esophagus was narrowed throughout. Patients with MMP, LP and CD had multiple erosions and superficial ulcers of the esophagus, unlike them in EoE. Autoimmune genesis of stricture development was morphologically confirmed in 100% of cases. The method of choice is a combination of endoscopic treatment and specific treatment. Each dilatation session provokes the main disease, and forced bougienage can lead to complications, so endoscopic manual should be performed in stages, in a “gentle” mode.

Results:

On the 14th day after dilatation, all patients reported an improvement in the condition – the result of treatment in all 57 patients (100%) was good. A year later, 48 (84%) patients were under observation, 12 of them (25%) were compensated, and no data for recurrent stricture were obtained. In 28 (58%) patients with dysphagia of 2 – 3 points, X-rays showed that they had a recurrent stricture, which required repeated complex treatment. After 3 years 39 (68%) patients were inspected. A satisfactory result was in 9 (23%) patients; a recurrence of stricture was detected in 30 (77%) patients.

Conclusions:

The main minimally invasive method of treatment is endoscopic bougienage, which should be carried out in stages, in a “gentle” mode, and certainly with the specific treatment to autoimmune diseases.