The introduction of augmented reality (AR) technology in surgery makes it possible to create the effect of “transparent” surgical anatomy and facilitate intraoperative visualization of anatomical structures hidden in the tissue thickness in the surgical area. The purpose of the study is to evaluate the experience of implementing augmented reality technology in performing high-tech laparoscopic interventions. Materials and methods. Using intraoperative AR technology, we performed 48 high-tech laparoscopic interventions: 16 adrenalectomies (7 right-sided and 9 left-sided), 16 liver resections, 10 clipping of the splenic artery with its aneurysm, 2 resections of the pancreas, 4 excision of spleen cysts. Results. Virtual 3D-models of the operational area, created on the basis of computed tomography, were effectively used in performing all surgical interventions. The 3D-model loaded into augmented reality glasses was intraoperatively positioned on the monitor of the laparoscopic video system, which made it possible in all cases to identify the necessary anatomical structures and perform interventions in the normal mode. Conclusion. Augmented reality technology is an effective method of intraoperative navigation during laparoscopic interventions, especially high-tech ones, when a clear orientation in complex anatomical areas is required.

Introduction. Diffusely infiltrative esophageal cancer is extremely rare; publications are limited to descriptions of sporadic clinical observations. Differential diagnosis and morphological verification are extremely difficult, which lead to accurate diagnosis delays. This type of tumor growth can be both primary and secondary, for example, with metastasis of breast cancer. Aim. To consider various endoscopic semiotics of diffuse infiltrative esophageal cancer and analyze the difficulties of differential diagnosis with other pathological conditions of the esophagus based on our own experience. Materials and methods. From 2013 to 2024 endoscopic examination suggested suspicion of infiltrative malignant lesion in 10 patients with complaints of dysphagia. A group of 14 patients with benign stenotic diseases of the esophagus was examined for the purpose of endoscopic differential diagnostics. Results. Based on the results of endoscopic, radiation and morphological diagnostic methods, 7 out of 10 patients were recommended to consult surgeons and oncologists. Self-expanding endoprostheses were installed in 3 patients. 1 of the 14 patients with benign stenosis of the esophagus was operated - enucleation with verified fibromyomatosis. The rest underwent bougienage or balloon dilation in combination with antisecretory, antacid and mucoprotective therapy with good results. In complex cases, the high efficiency of endoscopic treatment methods indicates the benign nature of the disease. However, it is extremely important not to lose vigilance and not to forget about the possibility of progression and malignancy with long-term tissue alteration. Conclusion. Infiltrative esophageal cancer is rare and difficult to diagnose. Disease progression and invasiveness determine an unfavorable prognosis. In order to reduce the percentage of late diagnosis and improve treatment results, close attention to all patients with dysphagia and their timely referral to expert institutions is required.

Barrett’s esophagus (BE) is an precancerous condition in which the squamous epithelium of the esophagus is transformed into a columnar epithelium under the influence of the constant reflux of acid. Barrett’s esophagus precedes the development of adenocarcinoma, the incidence of which, according to various authors, has increased significantly over the past decades. However, with timely detection and treatment of Barrett’s esophagus and dysplasia, it is possible to stop neoplastic progression and, subsequently, affect the reduction of mortality from invasive adenocarcinoma of the esophagus. In the endoscopy department of the P.A. Herzen Moscow Oncology Research Institute, 760 patients were examined in 2012-2024, in whom Barrett’s esophagus was detected during upper endoscopy. The disease was detected in men 2 times more often than in women (526 vs 254). In more than half of the patients, we observed a long segment of BE metaplasia (55.3% [95% CI: 51.7%-58.8%]). Different types of epithelial neoplasia were detected in 177 examined patients, which accounted for 23% of the total number of patients with BE. It was found that the greatest number of be changes were detected within a long segment of metaplasia (74.5% [95% CI: 68.1%-80.9%]). In less than 24% of cases [95% CI: 17.4%-30.0%], neoplasias were found within the short segment of BE. We identified a number of signs of low- and high-grade dysplasia, as well as non-invasive Barrett’s carcinoma.

The aim of the study - evaluate the one center results of endoscopic interventions in patients with esophageal submucosal tumors. Materials and methods. From 2017 to 2024, endoscopic interventions for esophageal subepithelial tumors were performed in 72 patients: endoscopic dissection of the neoplasm in 3 patients, tunnel endoscopic interventions were performed in 67 patients aged 18 to 67 years (mean age 47.45 ± 12.2 years) (women - 45, men 27). Results. The duration of the tunnel surgery ranged from 45 to 210 minutes (on average 116.56 minutes). The tumors were completely removed. When the tumor was localized in the II echo layer, the duration of the intervention did not exceed 30 minutes. We had difficulties in treatment 7 patients with pleximorphic tumors. The intervention plan was changed in 3 cases - the tumors were removed and clipping of mucosa defect was perfomed. Fragmentation of the tumor before its extraction was used in 7 cases with tumor sizes of more than 4 cm. We didn’t have complications during the operation and postoperative period. In all cases, the tumors were completely removed. According to the results of pathomorphological and immunohistochemical studies, leiomyoma was diagnosed in 68-94.44% of patients, gastrointestinal stromal tumor with a high mitotic index in 2 (2.77%), and Abrikosov tumor in 2 (2.77%). Conclusions. Interventions for submucosal tumors of the esophagus and esophagogastric junction are highly effective and safe. Endoscopic ultrasound examination is mandatory to tumor visualization, determine the true size, the esophageal wall layer. It always allows to determine the true type of tumor. Safe use of tunnel endoscopic interventions is possible for tumors larger than 4 cm with isolat

Purpose of the study. Demonstration of the experience of successful treatment of patients with the failure of the stapler suture line using various endoscopic technologies. Material and methods. In the period from December 2023 to January 2024, a 46-year-old patient with a body mass index of 51.3 and a 40-year-old patient with a body mass index of 49.3 were treated at the Vishnevsky National Research Medical Center for Surgery, who underwent laparoscopic sleeve gastric resection for morbid obesity. Results. In the first clinical observation, on the 4th day after surgery, the inconsistency of the stapler suture line was revealed. Taking into account the remaining area of failure of the stapler seam line after drainage under ultrasound control, the defect was closed using an OVESCO endoscopic clip. In the second clinical observation, due to the formation of a large cavity with a diameter of 9 cm, a vacuum aspiration system was installed. Subsequently, after removal of the vacuum aspiration system, due to the persistent defect in the wall of the stomach stump, the defect was also closed using an OVESCO endoscopic clip. Conclusion. Our study demonstrates the possibilities of intraluminal endoscopic technologies in the treatment of bariatric patients with staple suture line failure. Thus, the endoscopic approach in the treatment of patients with failure of the stapler suture line after bariatric interventions is a modern minimally invasive technique and an alternative to surgical interventions, provided adequate sanitation and drainage of abdominal congestion.

Aim. To evaluate the role of the choice of endoscopic surgery in the treatment of patients with adenomas of the major duodenal papilla, using a developed endoscopic classification of adenomas. Material and methods. From 2000 to 2024, endoscopic removal of adenomas of the major duodenal papilla was performed in 200 patients. In 165 cases, endosonography was used at the diagnostic stage, while in 35 cases, this diagnostic method was not applied. Results. The technical success rate for endoscopic removal of adenomas of the major duodenal papilla was 100% in both groups. The frequency of postoperative complications in the main group was 16.9%, while in the comparison group it was 40%. In the long-term period, the recurrence rate of adenomas was observed in 6.6% of cases in the main group and in 20% of cases in the comparison group. Conclusion. A personalized selection of the optimal surgical intervention method for the removal of adenomas of the major duodenal papilla, based on the classification typology of the neoplasm, allows for minimizing the risk of postoperative complications and increasing the radicality of the intervention.

The aim of the study was to evaluate the effectiveness of endoscopic retrograde cholangiopancreatography after short-loop Billrot II surgeries. Results. An analysis of 11 cases of 22 cases of endoscopic retrograde cholangiopancreatography (ERCP) after short-loop Billrot II surgeries was performed. Distal malignant strictures of the bile ducts were an indication for surgery in 6 cases, gallstones in 16. The success rate of choledochal catheterization was 100%, and the success rate of surgery was 95%. In one case, it was not possible to install a plastic stent with a dense stricture of the bile duct formed by a tumor of the pancreatic head. Stone removal using traditional baskets was effective in 100% of cases. Successful installation of plastic stents was performed in 12 cases (strictures - 4, complicated bile duct stones - 8). Conclusion. Endoscopic interventions in the pancreatobiliary zone after gastric resection with the formation of a Billrot II anastomosis are technically difficult and must be performed by an experienced endoscopist. Special technical devices and tools have been introduced to facilitate such operations. Endoscopes with end optics have some advantages in positioning, cannulation, sphincterotomy, and calculus extraction, but there are some limitations in stenting capabilities compared to traditional duodenoscopes, such as maximum stent diameter and pressure force.

Introduction. The article summarizes the results of a long period of practical and analytical work of the endoscopic department of the Petrovsky National Research Centre of Surgery in treating patients with benign cicatricial strictures of the esophagus and esophageal anastomoses. Aim: to adjust the scale for assessing the immediate results of endoscopic treatment of benign cicatricial strictures of the esophagus and esophageal anastomoses and to supplement the classification of benign stenoses with a definition of the concept of “complex stricture”. Main part. Based on the analysis of many years of experience in endoscopic treatment of more than 1,500 patients in this category, the prerequisites for the need to revise the criteria for assessing immediate results are considered due to changes in the quality and arsenal of tools that allow for safe achievement of a larger lumen in the stenosis zone, including in patients with resistant stenoses. The results of endoscopic treatment of 82 patients with complex strictures using intramural steroid injections are demonstrated in comparison with 27 patients with complex strictures who underwent a standard treatment protocol. Two appendices provide a step-by-step comparison of the previous and updated assessment scales and a modified classification of benign cicatricial strictures of the esophagus and esophageal anastomoses (2025) with criteria for complex strictures and forms of stricture resistance to the treatment. Conclusion. The modified classification of strictures with criteria for the multiple concept of “complex stricture” will draw attention to an extremely complicated, but small group of patients who require a non-standard personalized approach and treatment in expert institutions engaged in both endoscopic and surgical treatment of esophageal diseases. The refined scale for assessing immediate treatment results has become even more rigorous in defining excellent and good results, taking into account both the changed arsenal of tools for dilating strictures and safety assessment of achieving such results in a large group of patients. This allows us to recommend it for wide clinical use.

Introduction. Gastritis cystica profunda (GCP) is a rare form of chronic gastritis characterized by cystic dilation of glands in the mucosa and submucosal layer of the gastric wall. Despite the presence of the described endoscopic and morphological signs, the pathology remains insufficiently studied. Objective. Evaluation of endoscopic and endosonographic characteristics of GCP based on clinical observations detected in the endoscopy department of the P.A. Hertsen Moscow Oncology Research Institute. Materials and methods. A retrospective analysis of 5 cases of GCP detected in the P.A. Hertsen Moscow Oncology Research Institute in 2012-2024 was conducted. Results. The analysis revealed that most patients (80%) had club-shaped thickened folds of the mucous membrane with a bumpy surface. Endosonography revealed anechoic cysts in the mucosa and/or submucosal layer of the stomach wall in 100% of cases. In one of the observations, a unique case of GCP was registered in the zone of heterotopia of the gastric mucosa in the esophagus, which is a rare phenomenon in world practice. The diagnosis of GCP was morphologically confirmed in all patients, including by loop electroresection of a fragment of the mucosa and submucosal layer of the stomach wall. Conclusion. The results of the study confirm the importance of a comprehensive endoscopic study for the accurate diagnosis of GCP and its differentiation from other gastric pathologies. The data obtained indicate the need for further research in the field of GCP pathogenesis, in particular, its oncogenic potential.

Aim. To determine the diagnostic information content of various research methods for diagnosis, differential diagnosis, and determination of the degree of activity of inflammatory bowel diseases. Materials and methods. 210 patients with ulcerative colitis (UC) and Crohn’s disease (CD) were examined. All patients underwent endoscopic colon examination using virtual chromoscopy (NBI) and autofluorescence (AFI), endosonographic examination (EUS), transabdominal ultrasound and computed tomography (CT) of the colon. The indicators of diagnostic and prognostic significance of the methods were calculated. Results. The results obtained during the study showed that the most informative methods for detecting UC and CD are NBI (UC: Se= 81%, Sp= 71%, BC: Se = 75%, Sp= 70%) and EUS (UC: Se = 90%, Sp= 81%, BC: Se = 74%, Sp= 80%). The above methods were also diagnostically and prognostically significant for the differential diagnosis of UC and CD (NBI: Se = 81%, Sp= 73%, EUS: Se = 81%, Sp= 74%). Clarifying the severity of UC inflammation through various examination methods showed the informative value of three methods: NBI (Se = 79%, Sp= 71%), EUS (Se = 86%, Sp= 67%) and CT (Se = 78%, Sp= 61%). Similar data were obtained when identifying the inflammatory phase of CD NBI (Se = 75%, Sp= 71%), EUS (Se = 71%, Sp= 64%) and CT (Se = 74%, Sp= 66%). The detection of neoplasia showed low figures of diagnostic significance of all radiation methods, while both NBI and API were informative (Se = 100%, Sp= 95%; Se = 87%, Sp= 80%, respectively). Conclusion. Summarizing the data obtained, algorithms for the diagnosis of IBD were developed at various stages of the examination of patients.

Aim. To determine the correlation of the level of insulin-like growth factor-1 (IGF-1) with the extent of the lesion, the degree of activity of ulcerative colitis (UC), the presence of pseudopolyps and neoplasia of the colon, as well as chronic pancreatitis. Materials and methods. 25 patients with UC aged 30-40 years were examined. All patients underwent endoscopic examination of the colon, endosonographic examination of the pancreas to verify the presence of criteria for chronic pancreatitis (CP) and a blood test for enzyme immunoassay for IGF-1 levels. A correlation analysis was performed with the calculation of Spearman’s rank correlation coefficient (CC) with the determination of the closeness of the relationship between the signs on the Chaddock scale. Results. The study of the dependence of the amount of IGF-1 in the blood serum and the severity of inflammation in the colon showed a high degree of closeness, the CC was equal to -0.871. A significant correlation was also found with the presence of CP in UC (CC -0.601). The determination of the dependence of the presence of pseudopolyps and neoplasia of the colon and the level of IGF-1 did not show a statistically significant correlation between the studied signs. Conclusion. IGF-1 levels have an inverse correlation with the severity of inflammation in the colon and the presence of chronic pancreatitis in UC, which makes it possible to use the amount of this protein as a marker for verifying the degree of UC activity and the presence of CP.

The aim of the study was to compare the frequency of segmental detection of colon cancer during routine endoscopy with the results of surgical treatment of tumor intestinal obstruction together with paired molecular genetic analysis of CRC and the mucous membrane of the index segment of the colon from the standpoint of studying precancerous changes. Material and methods. In a continuous cross-sectional retrospective study, the results of 3086 colonoscopies and 63 surgical protocols of patients with tumor intestinal obstruction were studied. In a prospective study, 401 cell samples were studied: colon cancer - 118, index segment mucosa - 114, normal mucosa - 169. The relative expression levels of 9 miRNA markers associated with the development of CRC were determined: miR-135b-5p, -141-3p, -143-3p, -200a-3p, -20a-5p, -21-5p, -31-5p, -34a-5p, -92a-3p, small nuclear RNA U6, as well as miRNA-16-5p and -191-5p. The mRNA of the following genes was also assessed: MUC2, CDX2, NOX1, LGR5, SMAD4, MS4A12, TIMP1, Ki-67, TERT with normalization to the housekeeping genes PGK1 and PUM1. Results. The overall frequency of CRC detection during colonoscopy was 4.93% (152 cases). During colonoscopy and surgical interventions, cancers of the left half of the colon prevailed. The expression levels of miRNA and mRNA in tumors between colon segments vary significantly, which may hide some patterns, but allows us to talk about the uniqueness of each segment of the colon. The same expression levels in the index mucosa and in cancers were found for miRNA-200a in the ascending colon, for miRNA-21 in the rectum, for miRNA-34a and LGR5 in the left half. Tumors of different segments of the colon turned out to be heterogeneous in the studied mutations, however, there is no such diversity in the mucosa of different segments of the colon. Conclusion. The obtained results allow us to speak about the necessity of searching for precancerous changes during colonoscopy.

The aim of the research. Assessment of the localization features of epithelial neoplasms of the colon in residents of a large industrial center of Siberia. Materials and methods. A continuous cross-sectional retrospective study of the results of colonoscopies in 2019-2020. Results. Descriptions, conclusions and photos of 3086 colonoscopies were studied. The detection rate of adenomas was 31.8%. The total number of detected tumors was 1431. Analysis of 980 patients with detected tumors by decade of life showed an increase in the total number of detected tumors with age, but revealed significant differences in the frequency of detection of tumors before the age of 40 years and after 40 years (χ² = 38.8, p =0.0000). Single neoplasms occurred in 57% of cases. With age, the proportion of patients with several tumors in one or more parts of the colon significantly increased (χ²=15.317, p=0.009). Analysis of the localization of single tumors by section of the intestine showed their predominant location in the sigmoid colon; in other sections the frequency of occurrence was the same. The structure of the identified neoplasms varied significantly both in single tumors between sections of the colon, and in their combinations in one or more sections of the colon. The study showed low patient adherence to regular colonoscopy. Conclusion. The results obtained allow us to recommend starting a broad search for colon tumors in the fifth decade of life. The high frequency of synchronous epithelial neoplasms of different histological structures confirms the need for total colonoscopy in all cases. An additional argument for this is the approximately equal frequency of detection of adenomas in different parts of the colon.

Based on current data on the risks of recurrence of colon epithelial neoplasms after their endoscopic removal, it is advisable to identify its predictors, which was the aim of our study. The study included 668 patients, who underwent endoscopic resection of superficial colonic epithelial neoplasms in the Nizhny Novgorod Regional Oncology Dispensary from 2012 to 2020. The study included patients who were diagnosed with large epithelial benign and malignant (with an invasion depth within the mucosa) neoplasms of the colon measuring 20 mm or more. Their average size was 35.5 ± 0.68 mm (median - 30 mm). During data analysis, we identified factors, associated with an increased risk of recurrence of epithelial neoplasms after their intraluminal endoscopic resection. First of all, these include the localization of the tumor in the descending colon and rectum, as well as its elevated flat type (type IIa according to the Paris classification). The histological type of the neoplasm - moderately differentiated adenocarcinoma, is also reliably associated with a high risk of its recurrence. The use of ESD, completed by endoscopic loop resection, increases the risk of developing a residual tumor threefold. According to our data on the absence of local relapse after the modified ESD “String-to-ring”, we consider it appropriate to further use this technique in everyday practice, especially for the removal high-risk neoplasms.

The aim of the research. To ground the possibility of using the method of color analysis of digital endoscopic images for the formation of medical decision support programs by artificial intelligence in the screening of colorectal cancer and detection of precancerous changes in the mucosa before the appearance of neoplasms. Materials and methods. Retrospective analysis of endophoto series of videocolonoscopy in white light of 6 patients without malignant neoplasms of any localizations and without benign colorectal neoplasms - conditionally normal or unchanged mucosa and endophoto series of 12 patients with colorectal cancers of different localizations. A total of 64 images were analyzed, including mucosa - 48, tumor - 16. Image analysis was performed in Photoshop and ACDS14pro. The total pixel area of images was determined, including RGB channels (red, green, blue). We calculated the coefficients of RGB channel area ratios to the total image area, calculated the sum of simple coefficients for unchanged mucosa, for mucosa of the index segment in colorectal cancer, and for colorectal cancer. Results. The pixel areas of images of unchanged mucosa, index segment mucosa in colorectal cancer, and colorectal cancer are different from each other (χ²= 17,849, p= 0,00013). The shape of the pixel images also differs between normal mucosa and index segment mucosa. Conclusion. The results obtained allow us to consider this method promising for the development of programs for supporting physician decisions by artificial intelligence in the assessment of precancerous changes in the colonic mucosa in CRC screening.

Purpose of the review. The purpose of this review article is to explain the current problems and current trends in the treatment of patients with non-epithelial esophageal neoplasms. In particular, the results of the analysis of studies devoted to the evaluation of the efficacy and safety of endoscopic surgeries for non-epithelial esophageal tumors are presented. Thanks to the analysis of the publications selected for evaluation, it is possible to demonstrate the efficacy and safety of endoscopic surgeries. However, despite the minimally invasive nature of intraluminal interventions, a relatively high complication rate is noted, which is associated with the lack of standard criteria for selecting patients for endoscopic surgeries. Conclusion. Thus, after comparing the immediate and remote results of intraluminal endoscopic interventions, it can be concluded that endoscopic operations can be considered as an effective method of treatment for non-epithelial neoplasms of the esophagus. It should be noted that careful examination and personalized selection of patients is the key to successful treatment. However, the presence of a large number of controversial issues and uncertain data necessitates further study of this problem and large randomized studies.

Intestinal ultrasound using microbubble contrast agents or contrast-enhanced ultrasound (CEUS), is promising investigation allowing to perform quantitative and qualitative assessment of inflammatory changes of the intestinal wall such as its thickening, changes of the structure and abnormal microcirculation. This changes correlate with inflammation intensity and help to reveal complications including abscesses, strictures and fistulas in patients with Crohn’s disease. There has been established high sensitivity and moderate specificity of the method in diagnosis of active Inflammatory bowel disease (IBD). Because IBD is a chronic condition requiring frequent visualization to control treatment efficacy which should be safe, not expensive and accurate. CEUS fits these requirements and is not inferior to Computed Tomography and Magnetic Resonance Imaging.

Introduction. Endoscopic gastroplasty is a minimally invasive and, importantly, reversible method for treating patients with morbid obesity, performed transorally. The restrictive effect of this intervention is achieved by reducing the volume of the stomach, similar to laparoscopic sleeve resection, through the endoscopic placement of numerous endoluminal sutures that pass through all the walls of the stomach - starting from the antral part and extending to the upper third of the body of the stomach. The Apollo Overstitch™ system is used for this procedure. It is worth noting that this device was registered in the Russian Federation in 2024. Clinical observation. A 34-year-old female patient underwent endoscopic treatment at the A.V. Vishnevsky National Medical Research Center of Surgery for grade 3 morbid obesity. Results. In our clinical observation, we achieved convincing results in the treatment of a patient with grade 3 morbid obesity. The endoscopic approach used for performing gastroplasty not only allowed for a complete gastric restriction similar to laparoscopic sleeve gastrectomy but also minimized postoperative complications. Conclusion. Endoscopic gastroplasty in the treatment of patients with morbid obesity is an optimal, modern technique and a preferred alternative to traditional surgical interventions. The undeniable advantages of this method include a stable functional outcome, a low level of complications, and a short postoperative period, allowing for a rapid return of patients to their usual lifestyle without the need for prolonged rehabilitation.

Pancreatic cancer is a rather aggressive tumor that grows rapidly and metastasizes relatively early. The diagnosis of PPC is established on the basis of anamnestic, laboratory data and results of instrumental examination, however, nonspecificity of symptoms does not allow to detect the disease at early stages, in a large part of patients pancreatic malignancies are diagnosed already at stage III-IV. Among all neoplasms of the pancreas, neuroendocrine tumors are also distinguished. Radiofrequency ablation is an invasive intervention in which a local action of high temperature is performed locally on the tumor, resulting in the death of neoplastic cells. The method is based on the effect of high-frequency radio waves on pathologic tissues. In the NMI Center of Oncology named after N.N. Blokhin. N.N. Blokhin NMI Oncology Center performed 6 radiofrequency ablations of neuroendocrine tumors of the pancreas under the control of endoscopic ultrasonography. No complications were noted in the postoperative period. All patients were discharged with recommendations under the supervision of an oncologist at the place of residence. It was also noted that the quality of life and further course of the disease improved in patients with the introduction of this method of treatment

This clinical observation describes a rare case of delayed radiation-induced bile duct stricture after radiotherapy for Hodgkin’s lymphoma. The description of the endoscopic picture of post-radiation bile duct stricture is published for the first time. A 34 year old patient was referred to the P.A. Herzen Moscow Research Institute of Oncology with suspected pancreatic/extrahepatic bile ducts cancer for diagnosis and treatment. Biopsy was performed twice at a local hospital. The results of the morphological study do not allow making categorical conclusions. Cholangioscopy was performed at the Herzen Institute. Detected stenosis of the confluence and common bile duct over a length of 20 mm. Circular and longitudinal white scars, flat raised red areas (like a “geographical map”), as well as pseudopapillary areas and shapeless white deposits were on the walls of the bile ducts in the problem site. The vascular pattern is not differentiated, contact bleeding of moderate intensity. The lumen of the right lobar duct is preserved, the biliary mucosa is white with single circular scars, the vascular pattern is blurred. A biopsy was performed. The conclusion of the pathomorphological study - pronounced proliferation of glandular epithelium. The oncology council concluded that the patient had post-radiation stricture of the bile ducts, based on the anamnesis data (specific treatment of Hodgkin’s lymphoma with nodular sclerosis stage IV), radiation examination methods, endoscopic picture, pathomorphological conclusion. Endoscopic treatment - multi-stage endoscopic stenting - was recommended.

Background. According to Russian and foreign literature, chest goiter is one of the rare cases among diseases of the endocrine system, the occurrence of which is up to 10% among all thyroid pathologies. The atypical location of the goiter, in particular the chest, complicates diagnosis and gives a specific symptomatic picture, requiring special therapeutic and diagnostic tactics. The aim. Demonstration of a clinical case of cervical diffuse nodular goiter II st., subclinical thyrotoxicosis, a 72-year-old woman. Materials and methods. A demonstration of a clinical case of cervical diffuse nodular goiter II st., subclinical thyrotoxicosis, in a 72-year-old woman is presented. Results. The presented clinical case confirms the features of the course and morphology of recurrent goiter with localization in the mediastinum and in the chest space. Conclusion. This clinical case is of great interest due to the atypical localization of recurrent goiter in the anterior mediastinum, the difficulties of diagnosis, and the peculiarities of the technical performance of the operation. In the clinical case presented by us, an individual tactic of surgical treatment of a retrosternal goiter of the thyroid gland was chosen. In the postoperative period, it is necessary to be monitored by an endocrinologist, surgeon and neurologist. After the surgical intervention, monitoring of the patient’s condition is required for 6-12 months.

A clinical case of the use of ultrasound navigation in the installation of an unloading percutaneous endoscopic gastrostomy for the purpose of decompression of the stomach in patients with impaired gastric evacuation function in the presence of a previously formed gastric stoma is presented.