Ciddi akalazyada pnömatik dilatasyon ile birlikte perkutan endoskopik gastrostomi uygulaması

Erken tanı konulmayan akalazya kaşeksiye yol açabilir. Kaşektik hastalarda uygulanacak cerrahi girişim daha sık komplikasyona, uzun bir iyileşme periyoduna ya da ölüme neden olabilir. 2 yıllık dönemde disfaji yakınması olan ve yaklaşık 30 kg zayıflayan hasta kliniğimize sevk edildi. Aşırı kaşektik hastada kandidial özafajit tedavisi yapıldıktan sonra pnömatik dilatasyon uygulanmış olsa da kusmaları devam etti. Evde uzun süreli enteral beslenmesi için perkutan endoskopik gastrostomi (PEG) takıldı. 3 ay sonra normal yemek yemeye başladıktan sonra PEG çekildi. Çok nadir olarak görülen bu hasta grubunda PEG ile yapılan evde enteral beslenme definitif tedavi öncesi kazanç sağlar.

Anahtar Kelimeler:

Özofageal akalazya, endoskopik cerrahi işlem, balon dilatasyon

Pneumatic dilation and placement of Percutaneous Endoscopic Gastrostomy in severe achalasia

Achalasia that is not diagnosed on time may result in cachexia, which may cause more complications, longer period of recovery and even higher mortality following surgical interventions. A patient, complaining of dysphagia for 2 years and weight loss of 30 kilograms, was referred to our clinic. Although ballon dilatation was performed following medical treatment of candidal esophagitis in too faint patient, vomitting had been continued. Percutaneous Endoscopic Gastrostomy (PEG) for a long period of home enteral nutrition was placed.After 3 months the patient could start to eat, PEG had been taken. Home enteral nutrition via PEG is a highly cost-effective pretreatment method before the definitive therapy in this small group of patients with severe cachexia.

Keywords:

Esophageal achalasia, endoscopic surgical procedure, balloon dilation,

PDF

___

1) Beck W.C, Sharp K.W. Achalasia. Surg Clin North Am 2011;91(5):1031-7. Abir F 2) Modlin I, Kidd M, Bell R. Surgical treatment of achalasia: current status and controversies. Digestive Surgery 2004;21(3):165-76. 3) Sadowski D.C, Ackah F, Jiang B, Svenson L.W. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil 2010;22(9):256-61. 4) Woltman T.A, Pellegrini C.A, Oelschlager B.K. Achalasia. Surg Clin North Am 2005;85(3):483-93. 5) Dobrowolsky A, Fisichella P.M. The management of esophageal achalasia: from diagnosis to surgical treatment. Updates in Surgery 2014;66(1):23-9. 6) Moonen A.J, Boeckxstaens G.E. Management of achalasia. Gastroenterol Clin North Am 2013;42(1):45-55. 7) Dughera L, Chiaverina M, Cacciotella L, Cisarò F. Management of achalasia. Clinical and Experimental Gastroenterology 2011;4: 33-41. 8) Goldsmith P.J, Decadt B. Extreme achalasia presenting as anorexia nervosa. Case Reports in Surgery 2012;2012:985454.