Dvofazna scintigrafija jednjaka u ležećem/stojećem položaju i balon dilatacija kod ahalazije: 20 godina iskustva
Sažetak
Uvod/Cilj. Najčešća terapijska metoda za ahalaziju je balon dilatacija (BD). Scintigrafija jednjaka je potencijalno najpogodnija metoda za procenu ahalazije kvantifikovanjem ezofagealnog tranzita. Cilj rada je bio da se prikažu rezultati primene scintigrafije jednjaka (SJ) kod bolesnika sa ahalazijom lečenih BD u periodu od 1997. do 2016. godine i pronalaženje parametara pogodnih za predviđanje rezultata lečenja. Metode. Dvofazna SJ izvođena je u anteriornoj projekciji. Prva faza je rađena u ležećem položaju gutanjem 10 mL vode sa 18,5 MBq 99mTc. Druga faza je izvođena u stojećem položaju nakon gutanja 100 mL vode. Posle scintigrafije, izračunavan je indeks retencije (RI) korišćenjem registrovanih impulsa jednjaka i želuca. Kod 52 bolesnika – 34 muškaraca i 18 žena, životne dobi između 22 i 75 godina života, medijana 44 godine, urađena je SJ pre i posle BD. Kod 31 bolesnika urađene su samo po dve scintigrafije. Kod ostalih 21 bolesnika nastavljeni su praćenje i kontrolne scintigrafije, uključujući i bolesnike s neuspehom i ponovljenim BD. Kod 8 bolesnika, koji su dalje praćeni, ponovljena je BD. Modifikovana BD rađena je primenom Rigiflex balon dilatatora. Rezultati. Tipičan scintigrafski nalaz u ležećem položaju bio je pasivno ispunjavan
je jednjaka bez uočljivog motiliteta i kod većine bolesnika, njih 43 (83%), bila je odsutna eliminacija radionuklida u želudac. Procenjujući vrednosti RI pre prve BD i duže vreme posle nje, pokazano je da određene vrednosti RI ukazuju na remisiju ili relaps bolesti. Razlika vrednosti RI posle BD veća od 50% pokazala se kao pouzdan prediktor dugotrajne remisije. Starost i pol bolesnika nisu uticali na rezultat dilatacije, ali su bolesnici mlađi od 40 godina imali veći rizik od ranog neuspeha (6 bolesnika u toku prve godine posle BD). Nalaz SJ ukazao je na to da je prva BD bila inicijalno uspešna kod 50 bolesnika, a posle perioda praćenja kod 41 (79%) bolesnika. Zaključak. Dvofazna scintigrafija jednjaka u ležećem/stojećem položaju je najpogodnija metoda za dijagnostikovanje i praćenje ahalazije. Za procenu i predviđanje terapeutskog odgovora RI je važan pokazatelj. Razlika RI veća od 50% posle BD je pouzdani prediktor duže remisije. Starost i pol bolesnika ne utiču na rezultat dilatacije jednjaka, ali bolesnici mlađi od 40 godina imaju veći rizik od ranog neuspeha lečenja.
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