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conferenceseries.com
Volume 7, Issue 3 (Suppl) J Gastrointest Dig Syst, an open access journal
ISSN: 2161-069X Gastro 2017
June 12-13, 2017
June 12-13, 2017 Rome, Italy
11th Global
GastroenterologistsMeeting
J Gastrointest Dig Syst 2017, 7:3(Suppl)
DOI: 10.4172/2161-069X-C1-050
The treatment results of rectal fistulas in Crohn's disease - VAAFT
Danilov Mikhail, Atroshchenko Andrew, Pozdnyakov Stepan, Ruchkina Evgeniya and Khatkov Igor
Moscow Clinical Scientific Center, Russia
Treatment of fistulas of the rectum in Crohn's disease is a difficult task for both gastroenterologists and surgeons. Medicamental
treatment of this pathology is recommended as the first line of therapy, and surgical treatment serves to control severe septic
complications. The frequency of relapse in the surgical treatment of rectal fistula with the use of various methods can reach up to
55% and 70% if there is also Crohn's disease. Surgical interventions with the plastic component and the excision of the fistula show
good results, but they practically do not make sense in case of Crohn's disease. Mini-invasive interventions video-assisted anal fistula
treatment (VAAFT) is becoming increasingly popular, in the treatment of rectal fistulas in Crohn's disease, in particular. Our clinic
performed 12 procedures using video-endoscopic technologies (VAAFT) in patients with Crohn's disease, the comparison group
included patients who underwent ligation of the fistula in the intersphincteric space (LIFT)-18. In the first stage, setons were put
into all the patients, followed by operation in the period from one to three months. Patients of both groups did not differ in age and
sex (p=34), as well as in fistula types: Trans-sphincteric- VAAFT=8, LIFT=14, extra-sphincteric- VAAFT=4, LIFT=6 (p=45). The
groups did not significantly differ in the duration of the surgical intervention: VAAFT-28±5.2 min, LIFT-26±5.8 min (р=.12), pain
syndrome in the postoperative period (VAS scale) (p=.07), postoperative bed-day (4±1.2 and 4±1.4, p=.24). All patients in VAAFT-
group underwent the first stage of fistuloscopy, then the fistula was cleared from fibrin overlap, fistula ablation was performed in
the direction from the inner to the external opening, the internal opening was excised and sutured. According to the preoperative
examination (transanal US, MRI), there was an ischio-rectal lag associated with the fistula in two patients in the VAAFT group and
one in the LIFT group, and surgical intervention was supplemented by sanitation and drainage through the external fistula opening.
The median follow-up of the total sample of patients was 12.6 months. In two patients of the LIFT group (10%) and the 1st group
VAAFT (8.3%), the relapse of the disease was detected at different times: 6, 7 and 3 months, respectively (p=.18), the setons were
put into the patients once again; medicamentous therapy was continued (preparations of 5-ASA, hormones, and biological therapy).
Video-endoscopic treatment of rectum fistulas (VAAFT) in Crohn's disease is quite new and promising surgical technique that
demonstrates satisfactory results in both early postoperative and distant period. The small-traumatic nature of the technique makes
it possible to perform it in multiple and recurrent fistula of the rectum.
The endoscopic diagnosis of early gastric cancer
Shinichi Katsuki
Otaru Ekisaikai Hospital, Japan
The incidence of gastric cancer in Japan is very high. Therefore, we always focus on endoscopic diagnosis of early gastric cancer.
Early gastric cancer occurs in the mucous membrane and invades to the submucosal layer. The prognosis of gastric cancer
depends on its stage. We detect an initial lesion of gastric cancer by observing the mucous membrane closely using an endoscope．It
leads to a higher survival rate of gastric cancer. The first step of diagnosing early gastric cancer is to find suspicious lesions by white
light endoscopy. Close attention is paid to color changes of the lesions such as reddish or pale and to surface morphology changes
such as elevation or depression. The second step is image enhanced endoscopy (IEE). Basically, there are two IEE methods; dye-
based IEE (chromo-endoscopy) and equipment-based IEE (optical digital endoscopy). These methods enable us to recognize the
demarcation line (DL) of the background mucous membrane and the cancerous lesion. The representative optical digital endoscopy
is narrow band imaging system (NBI). NBI light is absorbed by hemoglobin contained in the blood vessels. With this light, we can
observe blood vessels in the mucous membrane and the submucosal layer and recognize the mucous membrane microstructure.
Consequently, we can diagnose early gastric cancer and identify tumor margins. The third step is magnifying observation of lesions.
We can determine whether there are any irregularities of micro-vascular architecture and superficial surface structure. When we find
either irregularity, the lesion is diagnosed as cancer.
shinichi