Modern possibilities of urgent fibroesophagogastroduodenoscopy in the diagnostic and therapeutic algorithm in patients with acute surgical pathology
Background. The role of fibroesophagogastroduodenoscopy is indisputable in diagnosing complications of peptic ulcer disease, but the endoscopic stage of treatment takes the leading place in the therapy of mechanical jaundice, pancreatic pseudocysts, acute high intestinal obstruction, which requires further improvement of the method and expansion of possibilities for its urgent use. Materials and methods. A retrospective analysis was performed of the medical records of patients hospitalized in the surgical department with suspected acute surgical abdominal pathology, who, according to urgent indications, underwent fibroesophagogastroduodenoscopy. In 377 patients, 489 urgent fibroesophagogastroduodenoscopies were performed. Indications for urgent fibroesophagogastroduodenoscopy were: suspicion or clinical picture of acute gastrointestinal bleeding — 225 (59.7 %) cases; differential diagnosis of acute surgical pathology when pain is localized in the upper abdominal region — 123 (32.6 %); suspicion or clinical pattern of foreign body in the upper gastrointestinal tract — 29 (7.7 %) persons. Results. In patients with suspected acute gastrointestinal bleeding, non-variceal bleeding was diagnosed in 171 (76 %) cases, and combined endoscopic hemostasis was performed in 61 patients. In 22 individuals, successful endoscopic removal of foreign bodies in the esophagus was carried out. In 33 (26.8 %) patients, a covered perforated ulcer was verified with the help of fibroesophagogastroduodenoscopy. In 22 (17.8 %) persons, signs of “compression from the outside” were revealed, which in 8 patients corresponded to the endoscopic symptom of the “pancreatic threshold” (pseudopancreatic cyst, parapancreatic infiltrate), and in 14 patients, compression of the lateral duodenal wall (subhepatic abscess, paravesical infiltrate) was detected. In 17 % of cases, acute surgical pathology was excluded, and gastroenterological pathology was verified with the help of fibroesophagogastroduodenoscopy. Conclusions. Urgent fibroesophagogastroduodenoscopy is a highly informative diagnostic method that allows for timely confirmation of acute surgical pathology and its correction.
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