The aim of the study was to compare endosonographic signs of pancreatic lesion in patients with inflammatory bowel diseases (IBD) and in patients with diagnosed chronic pancreatitis (CP). Materials and methods. 62 patients with IBD (39 with ulcerative colitis (UC), 23 with Crohn’s disease (CD)), 33 patients with previously established CP without IBD and 42 patients without CP and IBD were examined. All patients underwent endosonographic examination of the pancreas with an assessment of parenchymal and ductal criteria according to the Rosemont classification. Results. There was no statistically significant difference when comparing changes in the pancreas in UC and BC. Ductal disorders in patients with UC and CD were more common than in the control group. Parenchymal changes of the pancreas were statistically significantly more common in patients with IBD than in CP, and ductal, on the contrary, less common. At the same time, a significant difference was determined between the frequency of ductal changes in IBD and CP when compared with the control group. According to the Rosemont classification, certain CP was more common in patients with previously verified gland damage, probable - in patients with IBD. Conclusion. Based on the results of our study, with different etiologies of CP, endosonographic changes in the pancreas will manifest in different ways. A detailed approach to the etiology of CP will optimize the diagnosis and treatment of pancreatic insufficiency, and as a consequence of the underlying pathology of the intestine. Timely administration of therapy for changes in the pancreas can help to avoid progressive changes in the pancreas and improve the prognosis of the disease.

In abdominal surgery, after operations on the abdominal cavity, it is possible to develop disturbances in the normal coordinated propulsive motility of the gastrointestinal tract. This episode of gastrointestinal hypomotility or the state of dynamic ileus is referred to as postoperative ileus (POI) or postoperative gastrointestinal tract paresis. The incidence of POI in the clinic of abdominal surgery ranges from 10 to 30%. Chewing gum has been used in surgery to relieve postoperative intestinal obstruction since the early 21st century. The present review considers the main randomized clinical trials, reviews and meta-analyses on the study of the effect of chewing gum in abdominal surgery for the prevention of postoperative ileus. The data presented in the review indicate the effectiveness and safety of the use of chewing gum in the postoperative period for the prevention of POI in abdominal surgery and surgical interventions in related areas.

The pylorus is a complex of morphological formations that perform an anti-reflux function and the function of promoting the contents of the stomach into the duodenum. The scientific domestic and foreign literature presents many studies of the gastric side of the gastroduodenal junction, the pylorus, but there have been no studies of the functions and endoscopic anatomy of the bulbous side of the pylorus. This section is a difficult-to-reach “blind spot” for traditional flexible endoscopy. Therefore, it was decided to discover it with the possibilities of capsule endoscopy using the PillCam COLON2 video capsule from Given Imaging (Israel) with two cameras on opposite sides. This article presents an analysis of capsule endoscopy in 120 people, 60 mature and 60 elderly, half of them healthy, and half were sick, 56 men, 64 women. As a result, it was possible to study individual differences in the shapes of the orifice of the bulbous side of the pylorus in the opened and closed states. For the first time during capsule endoscopy, a circular fold with a width of 1 to 7 mm was discovered around the pyloric opening on the bulbous side of the pylorus, and the size of circular fold at which the antireflux function of the gastroduodenal junction is performed.

Artificial intelligence (AI) and digitalization are used in all spheres of life, including medicine: in making diagnoses, in working with patients, in creating and using an Electronic Medical Record (EMC) for fast and accessible document management. Attempts have been made repeatedly to facilitate work with medical protocols. Technologies related to speech recognition are a promising direction in this area. The purpose of the research work was to optimize the time of writing the protocol using voice input. The object of the study was a template protocol of endoscopic examination. This work was carried out on the basis of 2 large endoscopic centers in Moscow, created as part of the pilot project of the DM within the framework of the colorectal cancer screening program in the Russian Federation in 2021. The software of the Voice2Med Speech Technology Center (MDG) was used to fill out the research protocol. Using mathematical calculations, 4 metrics were created to evaluate the work of the software: the time of protocol formation; the proportion of protocol formation time from the study; the level of speech recognition accuracy; satisfaction of doctors when working with technology. Standardized protocol templates for various nosologies related to voice commands have been developed; medical thesaurus. In the course of the work, the accuracy of speech recognition was investigated and improved. Control measurements of the time of writing the protocol were carried out. The results of the evaluation of the use of the technology by endoscopists were obtained - the time of protocol formation decreased by 29%, the evaluation of the work by endoscopists was positive. Thus, the use of speech technologies related to the formation of a doctor’s protocol “from the voice” is a promising direction for the further development of the IT sphere in practical medicine.

Objective. To highlight the main criteria for selection of patients and materials for endoscopic stenting in stenotic esophageal cancer of different localization, to consider the key stages of surgery and its possible complications. Materials and Methods. 102 endoscopic stenting surgeries in patients with stenotic esophageal cancer of various degrees of obstruction were performed in S. P. Botkin GKB in the period from 2019 to 2021. The analysis of the literature data and comparison of the existing types of esophageal stents were performed, the stenting technique used in our clinic and the review of the causes of complications after endoscopic stenting were considered. Results. Endoscopic stenting in 101 cases (99%) was technically successful; in 99 patients (97%) stenting resulted in positive clinical effect. Conclusion. Endoscopic treatment of stenotic esophageal cancer is an effective and safe method of surgical treatment of patients with clinical manifestations of severe dysphagia.

The purpose of the study. Evaluation experience of endoscopic treatment of patients with Zenker’s diverticulum. Material and methods. In 2016-2022 endoscopic interventions for Zenker’s diverticulum were performed in 85 patients (40 - men, 45 - women). The duration of the age ranged from 32 to 86 years. The duration of the disease ranged from 1 months to 25 years. The sizes of the diverticula ranged from 10 to 70 mm. In 31 patients with Zenker’s diverticulum, surgery was performed using a flexible diverticuloscope, 44 patients were operated with a combined method. Results. The intervention time ranged 15 to 100 minutes. There were no complications during operation time. We had 10 adverse events in the postoperative period: hyperthermia, subcutaneous emphysema, partial suture failure with leakage. Patients were discharged from the hospital 3-5 days after the intervention. Repeated interventions were performed in 2 patients more than 1 year after surgery due to recurrence of complaints. During the examination in the postoperative period, no complaints were noted. Conclusion. Endoscopic interventions in the treatment of patients with Zenker’s diverticulum is an effective method of treatment with a minimum length of admitting for patients in the hospital. Important advantages of these operations are the early start of fluid and food intake in the postoperative period, the absence of the need a nasogastric tube insertion. The low invasiveness of operations and the short time of their execution allow the use of these interventions in patients of any age, with any size of the diverticulum, regardless of comorbidities. The absence of a cosmetic defect is an important advantage of endoscopic interventions.

A survey of 65 patients who had undergone COVID-19 and were admitted with a clinical picture of HH, reflux esophagitis was carried out. All patients underwent esophagogastroduodenoscopy, which was diagnosed with reflux esophagitis. According to the Los Angeles classification of esophagitis, grade C was diagnosed in 37 patients (56.9%), grade D in 28 patients (43.1%). In 43 patients (66.2%), there was a pronounced Hp contamination (+++), a moderately pronounced contamination (++) - in 22 patients (33.8%). The inclusion of exogenous nitric oxide in the complex therapy contributed to the eradication of Hp in 93.8% of patients and accelerated the epithelialization of erosions by 2.8-3.1 times compared with patients who did not receive nitric oxide in the complex therapy.

The aim. To analyze the results of treatment of achalasia cardia by balloon dilatation with an accent on hydrodilatation, to compare the types of achalasia cardia according to high-resolution manometry with endoscopic semiotics and to evaluate the effectiveness of endoscopic balloon dilatation depending on the type of achalasia. Materials and methods. The article details an additional method of endoscopic balloon dilatation of the cardia - hydrodilatation (42 patients). The results of endoscopic balloon dilatation were analyzed according to high-resolution manometry data (37 patients). High-resolution manometry data were also evaluated in correlation with endoscopic efficacy criteria (11 patients). Results. Hydrodilatation is used as an additional method after pneumodilatation to increase efficiency of treatment (39 patients) or as an independent method (3 patients) with a combination of achalasia cardia and cicatricial changes of the esophageal-gastric junction, as well as after surgery on the cardia. The combined balloon dilatation technique gives good immediate results in 89.7% (35/39), as an independent method - 100%. Of the total number of patients, 90.5% (38/42) completed the course of endoscopic dilatation with good results, despite the fact that this is a more complex group of patients resistant to standard intervention - balloon pneumodilatation. It is not known which high-resolution manometry data should be used to assess the effectiveness of balloon dilatation: the dilatation efficiency is 75% according to the resting pressure of the lower esophageal sphincter, 83.3% according to the total relaxation pressure, 66.7% according to the cumulative analysis, strictly adhering to the reference values, and 100% according to the tendency to lower pressure. Conclusion. Endoscopic balloon dilatation is a highly effective minimally invasive method of treating achalasia cardia. Hydrodilatation is used to improve the results of endoscopic treatment. For an objective assessment of the effectiveness of balloon dilatation, high-resolution manometry should be performed before and after treatment.

Relevance: PB is a dynamic state, regression and progression of the disease are possible in the same patient against the background of a long period of observation. Materials and methods. The study was conducted on the basis of the MMC BR in Moscow in the period from 2013 to 2023, both retrospectively and prospectively. The diagnosis of BE was established on the basis of the endoscopic picture (according to the Prague criteria) and the data of the morphological study of the biopsy material. As a result of the analysis, 122 patients were selected who were on inpatient and outpatient treatment, as well as dynamic observation. Examination of patients included: clinical data with an assessment of comorbid pathology, endoscopic examination with sampling of biopsy material, morphological, including immunohistochemical studies of biopsy material: determination of mutations in the P53, P63 genes and the nuclear proliferation marker Ki-67. The treatment was carried out in accordance with the clinical recommendations of the Russian Gastroenterological Association based on the developed algorithm and included conservative therapy for BE and identified comorbid pathology, as well as in groups of patients with low-grade dysplasia, endoscopic intraluminal treatment-argon plasma coagulation. Results. Analysis of the results made it possible to conclude that the applied algorithm was highly effective: high scores on the goal achievement scale were achieved in 88% of patients. Moreover, the greatest success was achieved in groups with low-grade dysplasia due to the use of personalized methods of treating patients with BE based on a deep clinical and morphological analysis, including, in addition to generally accepted, gender and age characteristics, assessment of comorbid pathology and the dynamics of P53, P63 and Ki-67 in determining the timing of dynamic follow-up of patients.

The purpose of the study is analyze of the results of peroral endoscopic myotomy in patients with esophageal achalasia. Material and methods. In the period 2017-2022 years peroral endoscopic myotomy in esophageal achalasia was performed in 110 patients (43 - men, 77 - women). Mean aged from 7 to 75 years. The duration of the disease ranged from 6 months to 40 years. Results. In 109 cases, the intervention was technically successful. The intervention was not successful due to the severity of fibrosis in the submucosal layer in 1 patient. The operation time ranged from 45 to 195 minutes. Complications during the intervention were in 9 (8,18%) patients. In the postoperative period, in 4 (3,63%) patients had complications that were eliminated by using flexible endoscopes. Patients were discharged from the hospital 3-5 days after the operation. There were not re-interventions performed. Erosive reflux esophagitis is the most common condition in the postoperative period. This condition was successfully stopped by inhibitors proton pump taking. When examining in the postoperative period and assessing the level quality of life using questionnaires SF-36, GIQLI and the Eckardt scale noted relief of dysphagia and a significant improvement in the main indicators. Conclusion. Peroral endoscopic myotomy in patients with esophageal achalasia can be the operation of choice in terms of efficiency, safety and long-term results, the level of quality of life in the postoperative period. To assess the long-term results of the intervention in this category of patients, further monitoring is required.

Functional disorders of the liver in chronic acalculous cholecystitis, manifested by intrahepatic cholestasis, require therapeutic correction. The aim of the study was to assess the functional state of the liver in patients with chronic acalculous cholecystitis and to develop therapeutic approaches to the identified changes. Materials and methods: 123 patients with chronic heart failure were examined on the basis of the gastroenterology department among the patients there were 90 women and 33 men with the duration of the disease from 5 to 10 years. The average age of patients was 43.74±1.26 years. To clarify the effect of cholestasis on the course of chronic acalculous cholecystitis, all examined patients were divided into two groups: patients chronic acalculous cholecystitis with cholestasis and patients chronic acalculous cholecystitis without cholestasis. The group of patients with cholestasis consisted of 84 people, whose average age was 46.46 (32.67; 60.25) years old, 22.62% were men, 77.38% were women. The group of patients without cholestasis consisted of 39 people with an average age of 43, 56 (28.44; 53.68) years, 13 (33.33%) men and 26 (66.66%) women. Results: the clinical course of chronic acalculous cholecystitis is determined by the presence or absence of intrahepatic cholestasis. Dyskinetic disorders of the gastrointestinal tract and the sphincter apparatus of the biliary tract are more common in patients with cholestasis, which in turn is formed against the background of gallbladder abnormalities in the form of various deformities, and leads to intrahepatic bile stagnation, biliary hypertension. Conclusion: the combined use of metronidazole, hemicromone and ademethionine contributes to the resolution of congestion in the intrahepatic bile ducts, normalization of tone and motor function of the gallbladder and sphincter apparatus of the hepatobiliary tract and reduction of clinical manifestations.

Objective. To conduct a clinical analysis of the surgical treatment of patients with spleen injuries in the Astrakhan region. Materials and methods. The data of 110 patients with spleen injuries of different sex and age who were hospitalized on an emergency basis in hospitals of the Astrakhan region and were in surgical departments from August 2017 to December 2022 were analyzed. Results. An analysis was made of 110 clinical cases of spleen injury in the Astrakhan region for the period from 08.2017 to December 2022. The distribution of patients by sex and age was carried out, the nature of spleen injuries, the localization of spleen wounds, the time of admission of patients from the moment of injury, the features of clinical manifestations, the choice of diagnostic method and surgical intervention were studied. Postoperative complications and causes of mortality after spleen injury, the number of bed-days spent in the hospital, depending on the type of surgical intervention, were analyzed. Conclusion. The use of hemostatic sutures for isolated splenic injuries makes it possible to increase the number of organ-preserving operations. In case of total ruptures, multiple wounds and damage to the vascular pedicle, it is recommended to perform splenectomy with autotransplantation of splenic tissue.

Gastrointestinal stromal tumors of the stomach are rare tumors, occur with a blurred clinical picture and are an accidental finding during esophagogastroduodenoscopy. Diagnosis and differential diagnosis of these tumors is a complex problem and is based on the endoscopic picture, data of endosonography of the stomach, the results of morphological and immunohistochemical studies of biopsy material obtained during endosonography.

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most informative and often in-demand methods for the detection and treatment of pathology of the biliary tract, its diagnostic value is 79-98%. A significant disadvantage of the method are side effects and various complications (acute pancreatitis, bleeding, retroduodenal perforation, cholangitis, acute cholecystitis, etc.). Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common and severe complication of intraluminal endoscopic operations on the large duodenal papilla, its etiology is multifactorial, and the pathophysiology has not yet been fully studied. According to many randomized, controlled studies, the incidence of PEP ranges from 2.7 to 37%. Despite all the possibilities of modern medicine and the introduction of new methods, mortality with the development of PEP remains at a very high level: it reaches 7-15%, and with the development of destructive forms - 40-70%. The problems of prevention of PEP are still the subject of discussions and numerous studies by leading clinics around the world. In this paper, we conducted a review of the literature over the past decade using the sources of major medical libraries Medline, eLibrary, PubMed. The article discusses current modern pathogenetic mechanisms and the main risk factors for the development of PEP, related to both the characteristics of the patient and the procedure being performed, technical options for performing ERCP. The article also presents currently used and recommended by most authors methods of drug prevention of PEP and various technical solutions related to this complication. Thus, the not entirely satisfactory results of the proposed methods of prevention of PEP force the authors to search for safer and more effective solutions to this urgent problem at the present time.

Non-epithelial tumors (NO) of the gastrointestinal tract (GIT) are a large heterogeneous group of neoplasms. OIs are characterized by the absence of a pathognomonic clinical picture, as well as by the fact that they cause difficulties both at the stage of endoscopic diagnosis and morphological examination. Often, the final diagnosis can be established only after a complete morphological diagnosis of the removed tumor. In most cases, an immunohistochemical study is required to make the diagnosis. Understanding the endoscopic manifestations provides an essential aid in the differential diagnosis. The article presents a review of the literature on the choice of method for endoscopic and endoscopic diagnosis of rare non-epithelial tumors of the gastrointestinal tract.

The problem of endoscopic diagnosis of early esophago-gastric junction cancer is one of the most important in modern endoscopy and oncology, since most malignant tumors of the esophagogastric junction are detected at late stage. The 5-year survival rate of such patients remains low. Definition of early esophagogastric junction cancer, resectability criteria, features of the course of the disease at early stage will be considered in this article. It has been proven that NBI-ME and NBI Dual Focus in combination with endosonography are the most accurate in the diagnosis of early esophagogastric junction cancer. The most typical endoscopic features of early esophagogastric junction cancer are discussed in this review. All these methods are applied to the patient in Herzen Moscow Cancer Research Institute, branch of National Medical Research Radiology Center.

This article describes 2 clinical cases of aorto-esophageal fistula (AEF) in patients after endoscopic stenting of the esophagus with a self-expanding mesh stent, which we encountered in our institution (City Clinical Oncology Center, St. Petersburg). In addition, a review of the available literature on this issue was carried out with a special focus on the risk factors for the development of AEF.

The article describes modern technologies of optical imaging in endoscopic diagnosis of colon neoplasms. The efficiency of these methods and features of their application in clinical practice have been evaluated.

To date, the diagnosis of both microcholedocholithiasis and anomalies of the pancreatobiliary maljunction is a difficult task. It is the improvement of the diagnostic algorithm for this category of patients that allows us to start timely treatment. In this clinical case, the diagnosis of microcholedocholithiasis and anomalies of the pancreatobiliary maljunction is described, which is extremely rare and causes difficulties in making a diagnosis and choosing a treatment strategy. The aim: to determine the information content of various types of research in the diagnosis of microcholedocholithiasis in anomalies of the pancreatobiliary fistula. Materials and methods: in the GKB im. S. P. Botkin received a patient with severe pain in the upper abdomen, weakness. In the emergency room, the patient underwent a complete blood count, biochemical blood test and transabdominal ultrasound, after transfer to the surgical department, MSCT and EUS were performed. Results: according to the results of EUS, it was revealed in the patient that the pancreatic duct opens into the common bile duct at a distance of 15 mm from the OBD zone, and calculi with a diameter of up to 2 mm were detected in the terminal bile duct. At the same time, the patient underwent retrograde transpapillary intervention with papillotomy and removal of the calculus. Conclusions: the combination of microcholedocholithiasis and anomalies of the pancreatobiliary maljunction is an extremely rare pathology. The use of a comprehensive therapeutic and diagnostic approach makes it possible to detect an anomaly of the pancreatobiliary maljunction and calculi with a diameter of 2 mm in the bile duct, which makes it possible to reasonably and timely perform surgical treatment avoiding the development of serious complications.

Relevance. Amyloidosis of the colon is a rare disease that occurs without clinical manifestations, and, as a rule, is an incidental finding during colonoscopy. In this regard, the authors presented a clinical case of a 68-year-old patient, whose diagnosis was established on the basis of an endoscopic picture and examination of biopsy material stained with Congo red solution under polarized light microscopy The purpose of the study was to demonstrate the clinical observation of colon amyloidosis Materials and methods. The case history of a 68-year-old patient diagnosed with amyloidosis of the colon is presented.

A rare clinical manifestation of pancreatic cancer, difficulties and diagnostic mistakes of the case are described.

The purpose of the study: to demonstrate the clinical observation of a patient who performed for colorectal cancer screening by capsule endoscopy. Key points: A 58-year-old patient came to the hospital for examination. Capsule endoscopy (CE) revealed a neoplastic lesion in sigmoid colon. The patient underwent endoscopic surgery. At the moment, the patient is under observation by an oncologist, there are no signs of recurrence of the neoplastic process. Conclusion: CE can be alternative screening method for colorectal cancer as well as standard colonoscopy.

A distinctive feature of pancreatic cancer is its aggressiveness and rapidity. Neuroendocrine tumors are distinguished among neoplasms of the pancreas. Pancreatic neuroendocrine tumors are diagnosed on the basis of anamnesis, laboratory tests and the results of instrumental studies. However, the non-specific character of symptoms does not allow early detection of the disease. In a large proportion of patients, pancreatic neoplasms are diagnosed at stages III-IV. Radiofrequency ablation is an invasive intervention with the high temperature local effect on the tumor, resulting in the death of neoplastic cells. The method is based on the effect of high-frequency radio waves on pathological tissues. 6 radiofrequency ablations of neuroendocrine tumors of the pancreas under the control of endoscopic ultrasonography were performed at the N. N. Blokhin Oncology Research Center. There were no complications in the postoperative period. All patients were discharged with recommendations for supervision of an oncologist at their place of residence. It is also noted that such a method of treatment improves the further course of the disease and the life quality in patients.

The article presents a translation of the chapters of the work “Onomatologia anatomica” (1880) by the Austrian anatomist Josef Hyrtl, devoted to terminology in large intestine anatomy; namely “Coecum”, “Colon”, “Rectum”.

The article is dedicated to the VI Eurasian Forum “UralEndo” held in Yekaterinburg in August 2022. Among the most actual topics of the forum this year were the issues of practical implementation in the practice of medical organizations at all levels, starting with primary care. The focus was on cancer screening, as well as the organization of the work of endoscopic units based on risk-oriented approaches in order to improve the safety and quality of endoscopic procedures for the patients benefits.