| Abstract | Bolesti kardioezofagealnog prijelaza opisane u ovom preglednom radu uključuju ahalaziju, hijatalnu herniju, gastroezofagealnu refluksnu bolest, Mallory-Weissov sindrom te karcinome kardioezofagealnog prijelaza. Ahalazija nastaje progresivnom degeneracijom ganglijskih stanica jednjaka što dovodi do abnormalne relaksacije donjeg ezofagealnog sfinktera i poremećene peristaltike jednjaka. Kirurško liječenje uključuje laparoskopsku Hellerovu miotomiju i peroralnu endoskopsku miotomiju. Za hijatalnu herniju, koja se definira kao patološko stanje koje nastaje kada šuplji ili parenhimatozni organi prolabiraju iz trbušne šupljine kroz ezofagealni hijatus u prsnu šupljinu, kirurško liječenje jedina je opcija liječenja koja će omogućiti vraćanje prolabiranih trbušnih organa i ispraviti funkcionalne probleme uzrokovane hijatalnom hernijom. Trenutno je metoda izbora laparoskopska Nissenova fundoplikacija zbog toga što pacijenti liječeni laparoskopskim putem, za razliku od pacijenata liječenih otvorenim transabdominalnim ili transtorakalnim pristupom, imaju manju stopu postoperativnih komplikacija, kraće trajanje hospitalizacije i bolju kvalitetu života. Nadalje, kirurško liječenje gastroezofagealne refluksne bolesti, jedne od najčešćih benignih poremećaja gornjeg gastrointestinalnog trakta, temelji se na fundoplikaciji, Roux-en-Y želučanoj premosnici i endoskopskim antirefluksnim postupcima. Mallory-Weissovim sindromom smatra se više laceracija uzdužnog mišićnog sloja distalnog jednjaka, gastroezofagealnog spoja te kardije želudca. Kod pacijenata s aktivnim krvarenjem iz Mallory-Weissovih laceracija indicirana je endoskopska terapija te zaustavljanje krvarenja i zbrinjavanje laceracija koristeći endoskopske klipse, koagulaciju ili ligaciju postavljanjem endoskopskih gumica uz primjenu adrenalina. Posljednje, karcinom kardioezofagealnog prijelaza, koji se definira kao karcinom kojem je središte rasta tumora smješteno unutar kardioezofagelnog prijelaza, kirurški se liječi torakoabdominalnom ezofagektomijom s cervikalnom anastomozom ili bez nje, gastrektomijom s distalnom ezofagektomijom, minimalno invazivnim tehnikama i/ili neoadjuvantnom terapijom. |
| Abstract (english) | Diseases of the cardioesophageal junction described in this review include achalasia, hiatal hernia, gastroesophageal reflux disease, Mallory-Weiss syndrome, and carcinomas of the cardioesophageal junction. Achalasia is caused by the progressive degeneration of esophageal ganglion cells, which leads to abnormal relaxation of the lower esophageal sphincter and impaired esophageal peristalsis. Surgical treatment includes laparoscopic Heller myotomy and peroral endoscopic myotomy. For hiatal hernia, which is defined as a pathological condition that occurs when hollow or parenchymatous organs prolapse from the abdominal cavity through the esophageal hiatus into the chest cavity, surgical treatment is the only treatment option that will allow the prolapsed abdominal organs to return and correct the functional problems caused by the hiatal hernia. Currently, the method of choice is laparoscopic Nissen fundoplication, since patients treated laparoscopically, unlike patients treated with an open transabdominal or transthoracic approach, have a lower rate of postoperative complications, a shorter duration of hospitalization and a better quality of life. Furthermore, the surgical treatment of gastroesophageal reflux disease, one of the most common benign disorders of the upper gastrointestinal tract, is based on fundoplication, Roux-en-Y gastric bypass, and endoscopic antireflux procedures. Mallory-Weiss syndrome is considered multiple lacerations of the longitudinal muscle layer of the distal esophagus, the gastroesophageal junction, and the cardia of the stomach. In patients with active bleeding from Mallory-Weiss lacerations, endoscopic therapy is indicated, as well as stopping the bleeding and treating the lacerations using endoscopic clips, coagulation, or ligation by placing endoscopic rubber bands with the use of adrenaline. Lastly, cardioesophageal junction cancer, defined as cancer with the center of tumor growth located within the cardioesophageal junction, can surgically be treated with thoracoabdominal esophagectomy with or without cervical anastomosis, gastrectomy with distal esophagectomy, minimally invasive techniques, and/or neoadjuvant therapy. |
