ENDOSCOPIC FINDINGS AND TREATMENT OUTCOME IN CASES PRESENTING WITH DYSPHAGIA
AbstractBackground: Dysphagia results from impeded transport of liquids, solids, or both from the pharynx tothe stomach. Among the malignant lesions, carcinoma of oesophagus is the commonest cause. Ourobjective was to find out the frequency of different endoscopic lesions and outcome of the endoscopictherapeutic interventions in patients presenting with dysphagia. Methods: This descriptive study wasconducted at Department of Gastroenterology, Military Hospital Rawalpindi from June 2008 to May2009. Patients of dysphagia after their consent were interviewed about the symptoms. Relevantbiochemical investigations were done. Barium swallow and upper Gastrointestinal (GI) Endoscopywere carried out. Benign strictures were dilated with Savary Gilliard Dilators. Malignant strictures werefurther evaluated to decide treatment plan. In patients considered to have oesophageal dysmotility,pressure manometery was done before specific therapy. Results: Seventy nine patients were enrolled.Twenty-five had malignant strictures, out of those commonest was adenocarcinoma 14 (56%). Twentynine had benign strictures the commonest being Gastro-oesophageal Reflux Disease (GERD) relatedpeptic stricture 9 (31%). Fifteen had oesophageal dysmotility, and achalasia was present in 10 out ofthem. After evaluation 12 out of 25 patients with malignant strictures were considered fit for surgery.Self-expanding metal stents (SEMS) were passed in 5. All benign strictures were dilated with SavaryGillard dilators. Pneumatic balloon dilation was done in patients of achalasia. Conclusion: Thecommonest malignant lesion resulting in dysphagia was adenocarcinoma while in benign it was GERDrelated peptic stricture. Achalasia was most frequent in oesophageal motility disorders. Standard oftreatment for early oesophageal malignancy is surgical resection. SEMS is a reliable way to allaydysphagia in inoperable cases. Savary Gillard dilatation in benign, and pneumatic balloon achalasiadilatations are effective ways of treatment.Keywords: Dysphagia, Malignant strictures, Benign strictures, Motility disorders, Achalasia
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