Introduction. Esophageal schwannoma is a rare spindle cell tumor derived from Schwann cells. To date, only 17 cases of esophageal schwannoma have been reported, with most of them occurring in women over the age of 50 years. Surgical interventions using open (cervical approach, extirpation of the esophagus with simultaneous plasty of the gastric tube) and thoracoscopic approaches have long been considered standard methods of treating patients with nonepithelial tumors of the esophagus, but currently minimally invasive endoscopic interventions are widely used. Clinical case. The patient, 64 years old, was treated at the Vishnevsky National Research Medical Center for Surgery for a large schwannoma of the esophagus. Results. This article presents a rare clinical observation - removal of a large schwannoma of the esophagus using a hybrid approach. During a control endoscopic examination 4 months after surgery, no signs of residual tumor fragments, narrowing or pathological changes in the mucosa were found in the area of the previously performed dissection. Conclusion. The use of a hybrid approach for removing a large non-epithelial tumor of the esophagus using endoscopic dissection in the submucosal layer and subsequent extraction through the cervical approach made it possible to perform organ-saving surgery, minimize the risks of possible intraoperative and postoperative complications, thereby leading to a good clinical and functional result.

Background. Due to the high risk of malignancy, all adenomas of the major duodenal papilla, regardless of morphological structure, must be removed. Currently, the method of choice for adenomas of the major duodenal papilla is endoscopic surgery, with neoplasms of the major duodenal papilla with intraductal spread (types III and IV according to the endoscopic classification of neoplasms of the major duodenal papilla) representing particular difficulty for endoscopic techniques. The introduction of intraductal radiofrequency ablation into clinical practice provides new opportunities for minimally invasive treatment of patients with adenomas of the major duodenal papilla, including those with extensive spread to the bile and pancreatic ducts. Material and methods. From 2022 to 2024, 14 patients with adenomas of the major duodenal papilla with extension to the common bile and main pancreatic ducts underwent intraductal radiofrequency ablation. The extent of spread of the adenoma to the common bile duct ranged from 10 to 30 mm, to the main pancreatic duct - from 3 to 11 mm. Results. Technical success of intraductal RFA was achieved in all cases. Postoperative complications were noted in 3 cases, in which moderately severe post-manipulation pancreatitis developed. During a follow-up examination after 3-6 months, residual adenomatous growths were detected in 3 patients, which required a repeat session of intraductal RFA. All patients underwent stenting of the main pancreatic duct and the common bile duct was achieved in all cases. Conclusion. Intraductal radiofrequency ablation has opened up the possibility of endoscopic treatment of patients with adenomas of the major duodenal papilla, characterized by extensive spread to the common bile and main pancreatic ducts.

Purpose of the study: to attract the attention of endoscopists and doctors of other specialties to the problem of diagnosis and treatment of lichen planus of the esophagus. Materials and methods. From January 2010 to December 2023, lichen planus was the cause of dysphagia in 7 of 17 patients with unexplained cicatricial strictures of the esophagus. Our own experience and literature data on endoscopic semiotics and treatment of lichen planus of the esophagus are presented. Results of the study. Lichen planus is most often localized in the upper third of the esophagus and is accompanied by a narrowing of the esophageal lumen. The mucosa is hyperemic, dull, with areas of epithelial detachment, erosions, and fibrin deposits. All 7 patients had grade 2-3 esophageal strictures with isolated esophageal involvement (3) or oral involvement (4). Morphological changes were nonspecific: ulcerations, granulation tissue and fibrosis of the underlying layers, atrophy and thinning of the epidermis, acanthosis. Only in 2 cases apoptotic Civatte bodies were detected in the suprabasal layer, which is a characteristic feature of lichen planus of the esophagus. All patients underwent courses of endoscopic bougienage, supplemented by intramural injections of triamcinolone. This manipulations led to stabilization of the esophageal lumen at 10-15 mm without a tendency to restenosis. Conclusion. Further experience is needed to determine optimal treatment strategies, but it is critical to pay particular attention to symptom assessment in patients with skin disorders and odynophagia or dysphagia. These actions will facilitate an earlier diagnosis of lichen planus of the esophagus and increase the effectiveness of endoscopic treatment.

Purpose of the study: the concept of complex endoscopic treatment of refractory benign cicatricial strictures of the esophagus and esophageal anastomoses is outlined, including the methodology of long-term planned supportive bougienage with intramural injections of glucocorticosteroids based on our own extensive experience. The results of an analysis of immediate and first long-term results in this group are presented, as well as detailed recommendations for the management of patients after interventions. Materials and methods. For the period from 2013 to 2023 in the endoscopic department of the Federal State Budgetary Institution “Petrovsky National Research Center of Surgery” 70 patients with refractory cicatricial strictures of the esophagus and anastomoses underwent complex endoscopic treatment, including the main course and long-term planned supportive bougienage, supplemented with intramural injections of Dexamethasone and triamcinolone according to the protocol we developed. Results. Of the total number of patients, 16 (23%) patients, after one or several courses of intramural steroid injections, did not have restenosis for 1 year or more, and 38 (54%) patients required no more than 3 sessions of prophylactic bougienage. In 49 (70%) patients, the duration of treatment was less than 1 year, and the average number of bougienage sessions was from 11 to 20. Conclusion. During the endoscopic treatment of patients with esophageal stenoses of various etiologies and strictures of the esophageal anastomoses, it is very important to assess the refractoriness of the narrowing at an early stage and determine the indications for intramural injections of glucocorticosteroids. Only if all recommendations and a regimen of long-term planned supportive bougienage are followed is it possible to achieve lasting stabilization of the lumen in the narrowing zone and avoid recurrence.

Purpose. To compare information about the condition of the digestive tract obtained by ex vivo radiometry and in vivo imaging methods after administration of¹⁷⁷Lu-DOTA-TATE to rats. Materials and methods. The compound¹⁷⁷Lu-DOTA-TATE was synthesized in the cyclotron-radiochemical laboratory of the Department of Radionuclide Diagnostics and Therapy of the N. N. Blokhin National Medical Research Center of Oncology. SPECT/CT method was used to visualize the digestive tract of laboratory rats after administration of¹⁷⁷Lu-DOTA-TATE. Classical direct radiometry of post mortem biological samples was used as a comparison method. In vivo imaging was performed sequentially in dynamic mode with MilLabs VECTOR6 small animal imaging system. In direct radiometry, signal from the radioisotope was detected with “WIZARD 2480” system. Safety of the compound¹⁷⁷Lu-DOTA-TATE was assessed with standard toxicological methods. Results. The safety of the compound was assessed. Biodistribution data was obtained with ex vivo and in vivo methods, the results were compared. Conclusion. In the preclinical toxicological study,¹⁷⁷Lu-based compound was recommended for further investigation. Pancreas uptake of the radioactive compound was consistent with literature data. For the small and large intestine, differences in feasibility of uptake detection with ex vivo and in vivo methods were shown. This fact should be taken into account when planning similar experiments for gastrointestinal cancer.

Aim. To evaluate the frequency of pseudopolypes (PP), as well as their histological structure in patients with inflammatory bowel diseases (IBD). Materials and methods. 165 patients with IBD were examined (113 with ulcerative colitis (UC), 52 with Crohn’s disease (CD)). All patients underwent ileocolonoscopy with taking the material for histological examination in case pseudopolypes were detected. Results. It was revealed that pseudopolypes were found in 27% of patients with IBD (in UC - in 29%, CD - 23%). In different phases of the inflammatory process in UC, the number of PP was comparable to each other. In CD, PP was statistically significantly more often detected at the stage of scars and outside of exacerbation than in the phases of infiltration and ulcers. During histological examination of biopsy material from PP tissue hyperplasia, inflammatory polyp and granulation tissue were verified. Adenoma was detected in one case in each of the IBD. Crypt abscesses and crypt discomplexation were found only with exacerbation of UC. Conclusion. Based on the results of our study, pseudopolypes occur in both UC and CD in different phases of the inflammatory process, which indicates the absence of specificity of these tumors for any of the IBD. The identification of a large number of PP at a pronounced stage of UC, in our opinion, indicates the connection of PP with an aggressive attack, which can serve as one of the criteria for predicting the course of UC. The cellular composition of PP in most cases reflected inflammation or healing of erosive and ulcerative defects, as well as in a small number of cases, the presence of adenoma. Thus, PP requires careful examination during endoscopic examination, if there is a suspicion of neoplasia or dysplasia in the PP tissue, biopsies must be taken for histological examination.

Racetams exhibit not only nootropic effects, but also affect the metabolism of fats and carbohydrates. Experimental studies have indicated the possibility of using phenylpiracetam in the treatment of obesity. At the same time, the molecular mechanisms of this pharmacological effect of phenylpiracetam are practically unknown. The paper presents the results of a new artificial intelligence (AI) method for comparative chemoreactome analysis of fonturacetam, piracetam, aniracetam, pramiracetam and levetiracetam. Another AI method, chemoneurocytological analysis, made it possible to compare the neuroprotective effects of molecules on neurons in culture. Despite the similarity of the proteomic interaction profiles of the studied molecules, differential analysis made it possible to establish the molecular mechanisms of the effect of phenylpiracetam on weight loss. Phenylpiracetam can activate β3-adrenoceptors, adenosine, glucagon-like peptide, sphingosine phosphate, and peroxisome proliferator receptors (PPARG); specifically inhibit cannabinoid, opioid, histamine, glutamate, nociceptin, neuropeptide Y and orexin receptors, which is important for normalizing appetite and improving the metabolism of adipose tissue. The synthetic AI method - pharmacoinformatic analysis indicated the advisability of taking phenylpiracetam together with vitamins C, D and group B.

Purpose of the study. The article It is devoted to the analysis of the influence of the patient’s sex on the frequency and localization of epithelial neoplasms of the colon. Materials and methods. In a continuous cross-sectional retrospective study we studied the results of 3086 colonoscopies for 2019-2020. Results. A cohort of. 980 patients with neoplasia. Analysis of localization and number of detected neoplasms depending on age and gender revealed a significant increase in the number of tumors after 40 years of life. The work confirmed the connection male sex with the frequency of colorectal neoplasms. However, there are significant differences in the frequency and neoplasia localization depending on the sex and age of patients with synchronous colorectal tumors. colorectal tumors. The association of chronic nonspecific inflammation is shown. with colorectal neoplasms. Conclusion. Age limits for screening colon tumors and positions requiring further study have been proposed.

Objective: To assess the alterations of gastric mucosa, its pathomorphological and functional characteristics in patients with complete erosions suffering from chronic heart failure II-III NYHA functional class. Materials and Methods: 185 patients with complete erosions comprised the main group, while the control group consisted of 183 patients with incomplete erosions of the stomach. Patients in both groups had chronic heart failure II-III NYHA functional class. All patients underwent esophagogastroduodenoscopy with white light imaging (WLI), narrow-band imaging (NBI), and ZOOM modes, as well as biopsy sampling followed by pathomorphological examination, determination of Helicobacter pylori presence, and endoscopic pH-metry. The diagnosis of chronic heart failure was established based on anamnestic data and the results of instrumental and functional diagnostic methods, including electrocardiography (ECG), echocardiography, Holter monitoring of ECG, stress echocardiography, and coronary angiography. Results: The study utilized the classification of gastric erosive lesions by K. Toljamo (2012), according to which in the main group, mature erosions subtype Ia were detected in 83.8% of cases, while immature extensive erosions subtype Ib were found in 16.2%. In combination with haemorrhagic erosions (type III), complete erosions were detected in 12.6% of cases, while with incomplete erosions of type II, they were found in 11.4%. The combination of complete erosions with erosive prepyloric changes (type IV) was identified in 8.7%. In the control group, gastric erosive lesions were mainly represented by type III (41%) and type IV (38.8%). Based on the analysis of endoscopic changes in the gastric mucosa using WLI, NBI, and ZOOM modes, the most characteristic visual changes were identified for each type and subtype of erosive gastric mucosa alterations. In patients with chronic heart failure II-III NYHA functional class, gastritis was noted in 75.1% of cases in the main group and in 58.5% in the control group. Helicobacter pylori infection of weak degree was determined in 40.5% in the main group and 37.7% in the control group. Evaluation of endoscopic pH-metry showed predominantly hypochlorhydria in both groups - 70.8% in the main group and 48.6% in the control group. Conclusion: By comparing the macroscopic features of various gastric erosive lesions in WLI, NBI, and ZOOM modes according to the classification by K. Toljamo (2012), the most characteristic signs for each type and subtype were identified. High prevalence of gastritis was established among patients with chronic heart failure II-III NYHA functional class.

Aim. To identify the informative value of various signs when using virtual chromoscopy (VC) and autofluorescence (AFI) methods during an endoscopic examination to determine the severity of the inflammatory process in ulcerative colitis (UC) and Crohn’s disease (CD). Materials and methods. 151 patients with IBD were examined (51 with CD, 100 with UC). All patients underwent endoscopic colon examination using virtual chromoscopy and autofluorescence functions and taking biopsy material for histological examination. Results. With a minimum degree of UC, the absence of venules was revealed at VC (p<0.05), as well as green staining with foci of purple color at AFI (p<0.05). A moderate degree was characterized by visualization of the venules of the submucosal layer (p<0.001) and purple staining of the mucous membrane (MM) with foci of green color (p<0.001). The pronounced degree of inflammation of MM in AFI was diffusely colored purple (p<0.001), and the absence of two types of vascular pattern during VC (p<0.001). In CD, the infiltration phase was characterized by visualization of two types of green staining in AFI mode in comparable amounts, which was statistically significantly more common than other colors (p=0.033 and p=0.006). In the phase of ulcers with VC, we mainly determined the visualization of either capillaries or venules in the same amounts (p<0.001). In the scar phase, the frequency of occurrence of various types of staining in AFI was comparable to that in the remission phase and with the control group, in VC - both types of vascular pattern were detected with a significantly high frequency (p=0.001). Conclusion. Based on the results of the study, VC and AFI are additional methods in diagnostics of the degree of IBD activity and can be used in difficult cases to clarify the severity of inflammation in patients with UC and CD.

The purpose of this study was to study the phenotypes of eating behavior in patients with NAFLD and their determining factors. Discussion: fatty liver disease has a high prevalence (24-26%) with an upward trend in both developed and developing countries, and in the coming years may become one of the main causes of liver transplantation. The clinical features of the disease are in most cases its asymptomatic course, which can progress to fibrosis/cirrhosis and is associated with the risk of a number of serious extrahepatic diseases (cardiovascular, oncological and others). The mechanisms underlying the formation of increased health risks and disease prognosis are multifactorial. Metabolic disorders, orthorexia nervosa, eating disorders and vegetative effects are considered as possible pathogenetic mechanisms for increasing the risk of NAFLD incidence. Conclusion: the study showed that complex behavioral psycho-social factors are involved in the pathogenesis of NAFLD, and changing eating behavior is an important component of therapy. Dysfunctional eating behavior can be a barrier to long-term success from therapy.

This clinical case describes a rare combination of early stage cancer and sporadic neuroendocrine tumor in stomach. The patient 57 years old admitted to P. A. Hertsen Moscow Oncology Research Institute for diagnostics and treatment for the gastric adenoma. Upper GI endoscopy performed in P. A. Hertsen Institute, detected two tumors: a sporadic neuroendocrine tumor in the middle part of the body stomach and early cancer in the antrum. With NBI (Narrow-Band Imaging), signs of malignancy were found in both tumors. А plan for therapeutic and diagnostic endoscopic surgical interventions was implemented: two sequential endoscopic submucosal dissection (ESD). This treatment confirmed as radical, according to the results of the pathological examination.

Primary malignant melanoma of the esophagus is defined as a tumor, the frequency of which is 0.1-0.2% of all malignant lesions of the esophagus. This type of neoplasia is difficult to diagnose and is characterized by rapid progression, high recurrence rate and metastasis. Despite the diagnostic capabilities of X-ray examination methods, which make it possible to identify a tumor and determine its localization, the correct diagnosis can only be established by endoscopic examination of the upper digestive tract with biopsy and subsequent pathological and immunohistochemical studies. A 78 year-old male patient was admitted to the Herzen Moscow State Medical Institute with suspected esophageal cancer. It is known from the anamnesis, that the patient for 6 months notes a dysphagia, pain in the chest area. Based on the data of our expert endoscopic examination, we suspected primary esophageal melanoma with a mixed growth - exophytic and flat-type. According to the results of pathological examination of the biopsies, pigment epithelial-cell melanoma of the esophagus with high mitotic index (up to 3 mitosis figures per 1 sq.mm) with infiltrative growth type. This clinical case demonstrates the importance of a detailed endoscopic examination and performing a targeted biopsy, followed by expert pathological examination in the differential diagnosis of esophageal diseases characterized by pigmentation of mucosa.