Introducere: Metaplazia mucoasei esofagiene indiferent de tipul histopatologic (metaplazie gastrica sau intestinala) reprezinta consecinta unui reflux gastro-esofagian cronic. Abordarea diagnostico-terapeutica a acestei patologii necesita o atentie deosebita deoarece unele forme dispun de potential oncogen. Scopul lucrarii: ameliorarea rezultatelor tratamentului multimodal al pacientilor cu metaplazia mucoasei esofagiene prin implementarea metodelor noi de diagnostic endoscopic si histopatologic si elaborarea unui algoritm complex de tratament medicochirurgical. Material si metode: studiul reprezinta o cercetare prospectiva pe un lot de 61 pacienti cu metapazia mucoasei esofagiene diagnosticati si tratati in clinica de chirurgie nr. 4 a IMSP Spitalul Clinic Republican „Timofei Mosneaga” in perioada anilor 2016-2023. Rezultate: Diagnosticul pacientilor cu metaplazia mucoasei esofagiene in 100% cazuri a fost stabilit in baza examenului clinic (semne ale bolii de reflux > 92,3% sau cele extraesofagiene) si paraclinic (EDS NBI+, Near Focus + imuno/histopatologie). Tratamentul chirurgical a vizat doua etape consecutive: endoluminal si chirurgia laparoscopica antireflux, aplicate la pacientii care nu asociau displazie de grad avansat sau adenocarcinom in situ (49 cazuri, 80,32%). La 12 pacienti (19,67%) care au fost diagnosticati cu complicatii evolutive sau asociate s-a recurs la rezectii de esofag cu esofagoplastii ulterioare dupa caz. Concluzii: 1. Apariția modificărilor sub formă de esofag columnar metaplaziat sunt apreciate prin examenul endoscopic și morfologic obligatoriu, iar imunohistochimia favorizeaza diagnosticul. 2. Tratamentul multimodal: endoluminal (prin inlaturarea miniminvaziva a substratului palogic) si laparoscopic antireflux (prin rezolvarea verigii etiopatogenetice) reprezinta abordarea optima a metaplaziei esofagiene. 3. Etapizarea intervențiilor chirurgicale, supravegherea minuțioasă postoperatorie sunt pilonii de bază în ameliorare rezultatelor tratamentului pacienților cu metaplazie columnară de epiteliu al mucoasei esofagiene.

Introduction: Metaplasia of esophageal mucosa regardless of the histopathological type (gastric or intestinal metaplasia) represents the consequences of chronic gastroesophageal reflux. The diagnostic-therapeutic approach to this pathology requires special attention because some forms have oncogenic potential. Objective: improvement of the results of multimodal treatment of patients with esophageal metaplasia through the implementation of new methods of endoscopic and histopathologic diagnostic and drafting of a complex algorithm for medical and surgical treatment. Material and methods: the study represents a prospective study of a group of 61 patients with metaplasia of esophageal mucosa that were treated in Surgery Department Nr. 4 of „Timofei Moșneaga” Republican Clinical Hospital during the years 2016-2023. Results: the diagnostic of patients with metaplasia of esophageal mucosa in 100% cases was established based on clinical examination (signs of reflux disease > 92,3%, or extra esophageal) and paraclinic (Upper GI endoscopy, NBI+, Near Focus + immuno/histopathology). The surgical treatment involved two consecutive stages: endoluminal and laparoscopic antireflux surgery that was applied to patients who did not associate advanced dysplasia or adenocarcinoma in situ (49 cases 80,32%). For 12 patients (19,67%) that were diagnosed with evolutionary or associated complications, was resorted to esophageal resection with subsequent esophagoplasty as appropriate. Conclusions: 1.The appearance of changes in the form of an esophagus with columnar metaplasia are evaluated by the mandatory endoscopic and morphological examination, immunohistochemistry facilitates the diagnosis. 2. The multimodal treatment: endoluminal (by minimally invasive removal of the pathologic substrate) and laparoscopic antireflux (by solving the etiopathogenetic link) represents the optimal approach to esophageal metaplasia. 3. The staging of surgery, thorough postoperative surveillance are the basic pillars in improving the results of treatment of patients with epithelial columnar metaplasia of the esophageal mucosa.