Single article

DOI: 10.47026/2413-4864-2023-1-63-72

Igonin Yu.A., Dolgov D.O., Dolgov O.Yu.

Dynamics of Intestinal Content Fluctuations Anastomosed Small Intestine Loops as Marker in Diagnosis of Dumping Syndrome of Different Severity in Gastric Cancer Patients after Gastrectomy

Keywords: gastrectomy, dumping syndrome, dynamics of number of intestinal contents pellets, anastomosed small intestine loops, artificially created anatomical-physiological complex, intracavitary intestinal laser therapy

The aim: to study the effectiveness of the method of daily fibroesophagoejunoscopy in determining the number of pellets of intestinal contents in the newly created anatomical-physiological complex and related functional disorders, accompanied by the manifestation of clinical symptoms of dumping syndrome of varying severity. Materials and methods. The method of fibrogastroscopic examination was by 190 patients with gastric tract after gastrectomy carried out. All patients were diagnosed with dumping syndrome of varying severity. The study showed that the severity of clinical manifestations of dumping syndrome depends on the number of intestinal contents in the newly created anatomical-physiological complex depending on the time of day. For proof of body, observing the stage, 30 patients underwent a modified esophagogastroscopic examination method, which was proposed by us – daily fibroeophagoeunoscopy, as well as histological and histochemical studies to detect inflammatory changes in anastomosed loops of the small intestine. To determine the dependence of clinical manifestations of dumping syndrome on the number of intestinal pellets, all patients underwent intracavitary intestinal laser therapy with helium-neon laser ULF-01. Results. When analyzing and comparing the data obtained during daily fibroesoeunoscopy with the clinical manifestations of dumping syndrome of varying severity, it was found, that at different periods of the day the intensity of intestinal casting in anastomosed loops of the small intestine and clinical manifestations of the disease differ significantly. It was established, that in the morning hours, at all degrees of severity of dumping syndrome, there was a minimum number of pellets of intestinal contents in the newly created anatomical complex and, accordingly, there were minimal clinical manifestations of the disease. The study also showed that the increase in clinical symptoms in patients with dumping syndrome is clearly precisely in the daytime manifested. Conclusions. The findings suggest that daily fibroesophagoeunoscopy is a pathognomonic method for diagnosing dumping syndrome in gastric cancer patients after gastrectomy. The method made it possible to establish that the severity of clinical manifestations depends on the number of casts of intestinal content and the time of its exposure in the newly created anatomical complex. The clinical symptoms of dumping syndrome are most in the daytime pronounced. The method also made it possible to determine that the most effective time for laser therapy is the morning period.

References

  1. Repin V.N., Repin M.V., Gudkov O.S. et al. Aspekty diagnostiki i rekonstruktivno-vosstanovitel’noi khirurgii funktsional’nykh narushenii pishchevaritel’noi sistemy [Aspects of Diagnosis and Reconstructive Surgery of Functional-Nal Disorders of the Digestive System]. Permskii meditsinskii zhurnal, 2016, vol. XXXIII, no. 4, pp. 33–42.
  2. Velikolug K.A., Sizova Zh.M., Baranskaya E.K. Rol’ endoskopicheskikh issledovanii v ekspertno-reabilitatsionnoi diagnostike bol’nykh i invalidov s operirovannym zheludkom [The role of endoscopic examinations in the expert rehabilitation diagnosis of pain and disabled with operated stomach]. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii, 2012, no. 1, pp. 31–35.
  3. Gasieva O.Yu., Embutnieks Yu.V., Berezina O.I., Bordin D.S. Demping-sindrom: sovremennyi vzglyad na patogenez, diagnostiku i lechenie [Dumping syndrome: a modern perspective on pathogenesis, diagnosis and treatment]. Effektivnaya farmakoterapiya, 2022, vol. 18(14), pp. 42–47.
  4. Goncharik I.I., Zarya N.A. Postgastrektomicheskii sindrom [Postgastrectomy syndrome]. Voennaya meditsina, 2017, no. 4, pp. 2–6.
  5. Grenkov G.I., Lud N.G., Medvedskii V.E., Val’shonok O.N. Motorno-evakuatornaya funktsiya zheludochno-kishechnogo trakta u bol’nykh, perenesshikh operatsii na zheludke [Motor-evacuation function of the gastrointestinal tract in patients undergoing gastric surgery]. Novosti luchevoi diagnostiki, 2000, no 1, pp. 12–14.
  6. Zabrodin O.N., Strashnov V.I. Neirodistroficheskii komponent patogeneza ostrogo posleoperatsionnogo pankreatita i ego preduprezhdenie s pomoshch’yu endural’noi anestezii [Neurodystrophic component of the pathogenesis of acute postoperative pancreatitis and its prevention by endural anesthesia]. Klinicheskaya farmakologiya, 2018, vol. 16, no. 4, pp. 61–66.
  7. Koryachkin V.A., Strashnov V.I. Spinnomozgovaya i epidural’naya anesteziya: posobie dlya vrachei. 3-e izd., pererab. i dop. [Cerebrospinal and epidural anesthesia: a manual for doctors, 3rd]. St. Petersburg, 2000, 96 p.
  8. Krivigina E.V., Zhigaev G.F., Ludupova E.Yu. Endoskopiya v diagnostike i lechenii postgastrorezektsionnykh oslozhnenii [Endoscopy in the diagnosis and treatment of post-gastroresection complications]. Byulleten’ Vostochno-Sibirskogo nauchnogo tsentra Sibirskogo otdeleniya Rossiiskoi akademii meditsinskikh nauk, 2010, no. 3(73), pp. 360–363.
  9. Kurtseitov N.E. Primenenie diafragmokrurotomii po metodike A.G. Savinykh pri rekonstruktsii pishchevodno-kishechnogo anastomoza posle gastrektomii [The use of diaphragmocrutomy according to the method of A.G. Savinykh in the reconstruction of food-water-intestinal anastomosis after gastrectomy]. Byulleten’ Vostochno-Sibirskogo nauchnogo tsentra Sibirskogo otdeleniya Rossiiskoi akademii meditsinskikh nauk , 2015, no. 2(102), pp. 21–24.
  10. Loida Z., Gossrau R., Schibler T.H. Enzyme Histochemistry: Laboratory manual. Springer-Verlag, Berlin, 1979, 339 p. (Russ. ed.: Gistokhimiya fermentov. Moscow, Mir Publ., 1982, 272 p.).
  11. Merkulov G.A. Kurs patogistologicheskoi tekhniki. 5-e izd. [Pathohistological technology course. 5th ed.]. Leningrad, Medicine Publ., 1969, 423 p.
  12. Akimov V.P., Dvaladze L.G., Shubin A.V. et al. Novyi vzglyad na patogenez demping-sindroma [A New Look at the Pathogenesis of Dumping Syndrome]. Vestnik khirurgii, 2008, no. 4, pp. 37–38.
  13. Baryshev A.G., Khachatur’yan N.V., Valyakis D.A. et al. Otsenka funktsional’noi effektivnosti razlichnykh sposobov vosstanovleniya pishchevaritel’noi sistemy posle gastrektomii [Evaluation of the functional effectiveness of various ways to restore the digestive system after gastrectomy]. Innovatsionnaya meditsina Kubani, 2016, no. 3, pp. 27–32.
  14. Solenkova A.V., Lubnin Yu.A., Konovalov N.A. et al. Posleoperatsionnaya prodlennaya epidural’naya anal’geziya pri spinal’nykh neirokhirurgicheskikh vmeshatel’stvakh [Postoperative prolonged epidural analgesia in spinal neurosurgery]. Anesteziologiya i reanimatologiya, 2017, vol. 62(3), pp. 178–184.
  15. Trofimov D.N., Igonin Yu.A., Dolgov I.Yu. Oslozhneniya gastrektomii, sovremennye tendentsii v diagnostike i lechenii [Complications of gastrectomy, current trends in diagnosis and treatment]. Nizhegorodskii meditsinskii zhurnal, 2006, no. 1, pp. 110–112.
  16. Fedorov I.V. Pozdnie oslozhneniya zheludochnoi khirurgii [Late complications of gastric surgery]. Moskovskii khirurgicheskii zhurnal, 2015, no. 3(43), pp. 27–32.
  17. Olekseenko V., Efetov S.V., Zakharov V.A. et al. Funktsional’nye rezul’taty rekonstruktsii pishchevaritel’nogo trakta posle gastrektomii [Functional outcomes of digestive tract reconstruction after gastrectomy]. Khirurgiya, 2017, no. 1, pp. 36–41. DOI: 10.17116 / hirurgia2017136-41.
  18. Khomichuk A.L. Dinamika kliniko-metabolicheskikh pokazatelei u bol’nykh posle gastrektomii v protsesse personalizirovannoi dietoterapii s vklyucheniem enteral’nogo pitaniya [Dynamics of Clinical and Metabolic Parameters in Patients after Gastrectomy during Personalized Dietary Therapy with Enteral Nutrition Inclusion]. Rossiiskii meditsinskii zhurnal, 2013, no. 5, pp. 19–23.
  19. Chaichenko T.V. Postprandial’nyi gipoglikemicheskii sindrom [Postprandial hypoglycemic syndrome]. Oglyad literaturi, 2017, vol. 12, no. 2(1), pp. 273–278.
  20. Berg P., McCallum R Dumping Sindrome: A Review of the Current Concepts of Pathophysiology, Diagnosis and Treatment. Digestive Diseases and Sciences, 2016, vol. 61, iss. 1, pp. 11–18.
  21. Chaves Destefani A.C., Pathophysiolo G.Y. Dignosis and Treatment of dumping syndrome and its relation to bariatric surgery. Bras. Cir. Dig., 2016, 29 Suppl., 1(Suppl), pp. 116–119.
  22. Gudmundsson , JohnssonF., Joelsson B. The time pattern of gastroesophageal reflux. Scand J Gastroenterol., 1988, vol. 23, no.1, pp. 75–79.
  23. Hirschowitz B.I., Curtiss L.E., Peters C.W., Poland H. Demonstration of a new gastroscope, the fiberscope. Gastroenterology, 1958, vol. 35(1), p. 50.
  24. Micaleff A., Richard-Berthe C., Huyghe J. Esophagite de reflux. Resultates d’une enguete epidemiologique et endoscopique cher 679 patients realisee par 146 gastroenterologues de ville. Chir. Digest., 1986, vol. 15, no. Spec., pp. 8–14.
  25. Scarpellini E., Arts J., Karamanolis G. et al. International consensus on the diagnosis and management of dumping syndrome. Rev. Endocrinol, 2020, vol. 16(8), pp. 448–466.
  26. Shibata C., Ueno T., Kakyou M. et al. Results of reconstraction with jejuna pouch after gastrectomy: correlation with gastrointestinal motor activity. Surg., 2009, vol. 26, no. 3, pp. 177–186.
  27. Van Beek, Emous М., LavilleМ., Tack J. Dumping syndrome after esophageal gastric or bariatric surgery: pathophysiology, diagnosis and management. Obesity reviews, 2017, vol. 18, iss. 1, pp. 68–85.

About authors

Igonin Yuvenaliy A.
Candidate of Medical Sciences, Associate Professor, Head of the Department of General Surgery and Oncology, Chuvash State University, Russia, Cheboksary (yuvig54@gmail.com; ORCID: https://orcid.org/0000-0001-8548-5569)
Dolgov Dmitry O.
Resident of the Oncology Specialty, Chuvash State University, Russia, Cheboksary (ddolgov767@gmail.com; ORCID: https://orcid.org/0000-0002-8063-4745)
Dolgov Oleg Yu.
Head of Oncology Department No. 4 (Oncoabdominal), Republican Clinical Oncology Dispensary, Russia, Cheboksary (oleg.dolgov.68@mail.ru; ORCID: https://orcid.org/0000-0003-0274-3652)

Article link

Igonin Yu.A., Dolgov D.O., Dolgov O.Yu. Dynamics of Intestinal Content Fluctuations Anastomosed Small Intestine Loops as Marker in Diagnosis of Dumping Syndrome of Different Severity in Gastric Cancer Patients after Gastrectomy [Electronic resource] // Acta medica Eurasica. – 2023. – №1. P. 63-72. – URL: https://acta-medica-eurasica.ru/en/single/2023/1/8/. DOI: 10.47026/2413-4864-2023-1-63-72.