The role of endoscopic investigation in expertise and rehabilitation diagnostics of patients and disabled persons after stomach surgery

Aim of investigation. To determine the role of endoscopy in expertise and rehabilitational diagnostics of patients and disabled persons after stomach surgery.

Material and methods. Overall 156 patients after stomach and duodenum surgery were investigated (99 had «peptic ulcer» diagnosis and 57 – diagnosis of «stomach cancer»). In resected stomach diseases physical disability was mainly caused by dumping syndrome. Of all 52 patients (33,3%) had physical disability: II degree – 28,9%, III degree – 71,1%. Evaluation of anastomosis functional activity was carried out according to N.S.Rudoy classification (1996, 1997).

Results. At endoscopic investigation the combined lesions of gastro-intestinal tract were frequently observed: gastroesophageal reflux disease (GERD) – in 30 (19,2%) patients, acute erosions of the stomach stump – in 45 (37,5%), inflammatory changes in anastomosis region (anastomositis) – in 87 (72,5%). At morphological study pyloric and intestinal metaplasia was revealed in 108 (69,2%) patients, various degrees of glandular atrophy – in 82 (52,5%), polyps in anastomosis area – in 8 (5,1%), in 2 (1,2%) early relapse of stomach cancer anastomosis zone, in 3 (1,9%) – cancer of the stomach stump was diagnosed. In patients with operated stomach high degree (56,7%) of stomach stump mucosa contamination by Helicobacter pylori was preserved. According to chronometry data, functionally passive anastomosis was found in 47,3% of patients, functionally active anastomosis of the 1 degree – in 25,4%, of II degree – at 22,7%, of the III degree – at 4,6%. Authors give a new definition to the term «expertise and rehabilitational endoscopy» and the new diagnostic procedure is introduced into practice of medical and social examination for the first time.

Conclusions. Endoscopic investigations have the important value in expertise and rehabilitational diagnostics at examination of patients for establishment of physical disability degree on the basis of analysis of biological disorders transformation and assessment of type, degree and causes of social disability of the patient.

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