Kochhar Rakesh, Mittal Bhagwant Rai, Kumar Sunil, Bhattacharya Anish, Sethy Pradeepta Kumar, Dutta Usha
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Nucl Med Commun. 2007 Dec;28(12):920-3. doi: 10.1097/MNM.0b013e3282f1b966.
The mainstay of treatment of corrosive oesophageal strictures is endoscopic dilatation. However, even after adequate dilatation, some patients may continue to have dysphagia. An associated oesophageal motor dysfunction in such patients may contribute to the persistence of dysphagia.
To assess oesophageal motor dysfunction in patients with corrosive strictures using segmental and total oesophageal transit time by radionuclide scintigraphy.
Thirty-five patients with corrosive-induced oesophageal strictures were evaluated after having achieved a dilatation of 15 mm. All patients underwent barium swallow and upper endoscopy for assessment of stricture(s). Oesophageal motility was assessed by radionuclide scintigraphy using Tc sulfur colloid. Total oesophageal transit time (ETT) and segmental (upper, middle and lower third of oesophagus) ETT were determined.
Thirty-five patients (age 18-53 years) were evaluated. Twenty-eight (80%) patients had a single stricture while seven (20%) had either two or three strictures. Eighteen patients had no dysphagia, 13 patients had grade 1 dysphagia and four patients grade 2 dysphagia. Total ETT was prolonged in 12 patients. Upper, middle and lower third ETT was prolonged in four, seven and six patients, respectively. Length of the stricture correlated with prolongation of ETT as 6.66% patients with length < or = 5 cm, and 53.84% of patients with length >5 cm had prolonged total ETT (P=0.019). Patients with tortuous stricture had more prolongation of ETT as compared to those with straight strictures though it did not reach statistical significance. No significant correlation was observed between number of strictures and prolongation of total ETT. The severity of dysphagia correlated with prolongation of total ETT (P=0.011).
Oesophageal transit time as assessed by scintigraphy is prolonged in one-third of patients with corrosive-induced oesophageal strictures despite having achieved adequate dilatation. Prolongation of ETT correlates with length of the stricture and severity of dysphagia correlates with prolongation of total ETT. These observations suggest impairment of oesophageal motility in these patients.
腐蚀性食管狭窄的主要治疗方法是内镜扩张。然而，即使经过充分扩张，一些患者仍可能持续存在吞咽困难。此类患者伴有食管运动功能障碍可能导致吞咽困难持续存在。
通过放射性核素闪烁扫描术利用节段性和全食管通过时间评估腐蚀性狭窄患者的食管运动功能障碍。
35例腐蚀性食管狭窄患者在扩张至15毫米后接受评估。所有患者均接受吞钡检查和上消化道内镜检查以评估狭窄情况。使用锝硫胶体通过放射性核素闪烁扫描术评估食管动力。测定全食管通过时间（ETT）和节段性（食管上、中、下三分之一）ETT。
对35例患者（年龄18 - 53岁）进行了评估。28例（80%）患者有单一狭窄，7例（20%）患者有两个或三个狭窄。18例患者无吞咽困难，13例患者有1级吞咽困难，4例患者有2级吞咽困难。12例患者全ETT延长。食管上、中、下三分之一ETT分别在4例、7例和6例患者中延长。狭窄长度与ETT延长相关，狭窄长度≤5厘米的患者中6.66%全ETT延长，而狭窄长度＞5厘米的患者中53.84%全ETT延长（P = 0.019）。与直的狭窄患者相比，迂曲狭窄患者的ETT延长更明显，尽管未达到统计学意义。狭窄数量与全ETT延长之间未观察到显著相关性。吞咽困难的严重程度与全ETT延长相关（P = 0.011）。
尽管已实现充分扩张，但通过闪烁扫描术评估，三分之一的腐蚀性食管狭窄患者食管通过时间延长。ETT延长与狭窄长度相关，吞咽困难的严重程度与全ETT延长相关。这些观察结果提示这些患者存在食管动力障碍。
