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Endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of neoplastic and dysplastic formations of mucosa in the digestive tract


Author: Istrate Viorel
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2012
Scientific adviser: Gheorghe Ghidirim
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific council: DH 50-14.00.27
State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 12 September, 2012
Approved by NCAA on the 15 November, 2012

Abstract

Adobe PDF document0.49 Mb / in romanian

Keywords

dysplasic and neoplasic precancerous lesions, early cancer, mucosectomy, EMR, ESD.

Summary

The work is displayed on 139 pages and consists of the introduction, five chapters, final conclusions and practical recommendations, bibliography with 344 sources, 57 tables, 62 figures, 14 annexes. The obtained results are published in 17 scientific papers.

Field of Study: Endoscopic Surgery.

Purpose: To improve the treatment of precancerous lesions and early Cr of the GI-tract mucosa on the base studies and practical implementations of minimally invasive techniques for EMR and ESD.

Objectives of work. Finding technical features of different EMR and ESD methods, and their applicability on different segments of the GI-tract.

Novelty and scientific originality. For the first time electrical, physico-chemical characteristics and tissue aggression of solutions for submucosal elevation are studied. New methods of ME of difficult vaterien malignancies and endoscopic closing of major defects of the mucosa after ME in practice are invented, patented and implemented. The criteria and algorithm of applying the technical variant judging by the lesion characteristics and location are elaborated. The clinical, laboratory and endoscopical factors responsible for the ME complication were methodically studied, discrepancies between forceps-biopsy and final histology after ME are determined.

Solved scientific problem. To argue the possibility of the radical endoscopic treatment for precancerous lesions in R0 conditions, precancerous dysplastic lesions and early noninvasive Cr of the mucosa in GIT. Indications for specific types of ME, as an alternative treatment for conventional surgery for selected dysplastic and neoplasic lesions of the GI mucosa were argued. The potential risk of complications associated with the specific ME technics was established. The discrepancies between preoperative biopsy forceps, and integral histopathological analysis were solved.

Practical value of the work. The efficiency of endoscopic treatment of dysplasic and neoplasic precancerous lesions, of the non-invasive Cr of the GIT mucosa, using ME, was demonstrated. The technical and methodological options for the application of technical ME variant depending on the form of the Cr and the location have been determined. The complication rate during ME was determined and their endoscopic control in most of the cases was confirmed.

Implementation of scientific results. The findings were approved as Scientifically Valuable and subsequently implemented in the current activity of the Endoscopic Surgery ward of The Clinical Hospital of the Ministry of Health in RM and also in the teaching provided by The Department of Surgery no.1 “N.Anestiadi” of State University of Medicine and Pharmacy “N.Testemiţanu”.