This article discusses the current results of the organization and management of educational activities of the modern training center medical simulation center, Botkin hospital, using the tools of “lean management” with the latest implementation of the training process.

The aim of the study is the rationalizing of the strategy change of endoscopic diagnostics, follow-up and treatment of patients with Barrett’s esophagus. From 2007 to 2015 Barrett’s mucosa has been defined during upper endoscopy in 111 patients of the main group. Another 12 patients with Barrett’s esophagus were followed-up from 1995 to 2010-2015. Endoscopic argon-plasma coagulation of the abnormal areas of the Barrett’s mucosa was performed in 17, endoscopic mucosal resection in 2 patients. The result was the recovery of stratified squamous esophageal epithelium. The remaining 92 patients were treated only by drug therapy. None of the 111 patients in the main group and as well as 12 patients followed-up since 1995, had any progression of Barrett’s esophagus of any length metaplasia segment, nor on the expression of intestinal metaplasia or dysplasia. Extensive experience in endoscopic diagnostics of esophageal diseases and the use of high resolution and high definition endoscopes with a variety of additional features are the base of a correct diagnosis of Barrett’s esophagus.

Aim: Endoscopic diagnosis of changes in the upper gastrointestinal tract in patients with acute pancreatitis and pancreatic necrosis. Materials and Methods: The results of esophagogastroduodenoscopy (EGD), 238 patients with acute pancreatitis. Patients were divided into two groups: patients with acute pancreatitis (173) and patients with pancreatic necrosis (65). Results: In the group of patients with acute pancreatitis in 71.1 % of patients were registered changes in the mucosa of the upper gastrointestinal tract. A 28.9 % of patients no changes were observed. 11.6 % had changes in the gastric mucosa. 23.1 % of patients had changes in the duodenal mucous membrane. Edema longitudinal fold was found in 31.2 % of all patients, as a result, in 6 % of patients it was impossible to visualize the papilla. In the group of patients with pancreatic necrosis, in 100 % were registered changes in the upper gastrointestinal tract. In 8.5 % of patients was found esophagitis, 32 % had gastric erosive changes, and in 50 % of cases detected gastroduodenitis. Conclusion: Specific treatment aimed at protecting gastrointestinal mucosa is required for all patients with pancreatic necrosis.

An analysis of published data on the effectiveness of various methods of diagnosis of obstructive jaundice syndrome, caused by stones and bile duct strictures of various origins. We conducted an analysis of own data on the effectiveness and accuracy cholangioscopy and confocal laser confocal laser endomicroscopy (CLE) in the diagnosis of the causes of biliary obstruction. The efficacy of endoscopic retrograde cholangiopancreatography is considered in combination with additional methods of examination

Morphological diagnosis of the bile ducts diseases is important in clinical practice. The article presents literature data about the various methods of obtaining morphological material from the bile ducts. Assessed the sensitivity, specificity, overall accuracy and other parameters. Discussion of the technical aspects.

Using contingency tables and logistic regression in clinical studies reveal the interconnectedness of all qualitative characteristics and predictors of disease progression. The results are natural and suggests that the indicators of liver function and biliary system activity in chronic cholecystitis combined with opisthorchiasis interrelated, interdependent and mutually. The results of complex statistical analysis can determine predictors of disease progression, which should be used for timely treatment and preventive measures aimed at the prevention of disease progression.

The article discusses current possibilities of visualization of the biliary tract in persons with calculous cholecystitis of the group’s high operational and anesthetic risk. According to the results of the comparative analysis of the main characteristics of such diagnostic methods as ultrasound, MRI and RPH the authors come to the conclusion about the benefits of magnetic resonance imaging. This method showed the greatest sensitivity and accuracy in detecting calculous cholecystitis patients with high operative-anesthesiological risk

Purpose of the study - to assess the effectiveness of the diagnostic use of proton spectroscopy in focal lesions of the liver parenchyma. Material and methods: A 160 of the abdominal cavity of patients with focal lesions of the liver (36 patients - liver cancer (including cases of cholangiocarcinoma and cirrhosis, cancer); 28 patients - with single and multiple metastases in the liver parenchyma; 45 observation of single and multiple hemangiomas of the liver, 31 cases of infiltrative and cystic forms alveokokkovogo infiltrative lesion, 20 patients with liver parenchyma unchanged in the control group). The scanning protocol that included MR proton spectroscopy. The studies were conducted on the unit Philips Infinion 1,5T. In the spectrograms of proton spectra and tables were evaluated: height of the peaks; peak area; creatinine ratio of peak area to other metabolites; creatinine ratio of peak area to other metabolites; percentage of metabolites in the spectrum, represented as a relative value. Conclusion: The single-voxel proton spektoroskopiya has the potential to be used as differential diagnostic criteria of focal hepatic lesions.

Aim of study was determination of especially clinic and diagnostic erosive and ulcerative lesions of gastroduodenal zone in patients with abdominal angina. Materials and Methods. Results of diagnostic and treatment 96 patients with abdominal angina. Results. Upper gastrointestinal endoscopy revealed erosive lesions in 44 cases, the bulb ulcers - in 3 cases, diffuse atrophy of the mucous - in 43 cases, focal gastropathy - in 53 cases.

Majority of published data describing endocytoscopic examination of upper gastrointestinal tract mucosa, but in recent publications, it is reported, that endocytoscopy is suitable for small bowel, colon, respiratory tract and even peritoneum «optical biopsy». In number of articles possibilities of celiac sprue diagnostics with endocytoscopy is dicscussed, but small-bowel endocytoscopy is limited, due to absence of endocytoscopes, compatible with enteroscopes. More widely endocytoscopy is used in colon, mostly in lateral-spreading adenomas diagnostics. Prof. S-E. Kudo developed endocytoscopic classification of colonic mucosa changes, used for differential diagnostics and lesion mapping, describing hyperplasia, adenomas with different grades of intraepithelial neoplasia, non-invasive and invasive cancer. Some authors reported about good possibilities of endocytoscopy in inflammatory bowel disease diagnostics. Most of data, related to respiratory tract endocytoscopic examination, focused on precancerous conditions and early pharyngeal and lung cancer, and the preliminary results are promising, but, unfortunately, for now, endocytoscopy in bronchial tree is limited, due to lack of thin endocytoscopes. According to some article data, it is possible to use endocytoscopy not only in gastrointestinal and respiratory tract, but also in optical confirmation of peritoneal tumor dissemination in gastric and ovarian cancer patients, and - in bladder mucosa examination

Literature review on colorectal stenting in malignant large bowel obstruction in comparison with surgery in different clinical situations supplemented by own retrospective analysis of stenting (56 patients) versus palliative surgery (50 patients) was performed. Stenting demonstrated lower levels of early complications (3,6 % / 22 %) and in-hospital mortality (1,8 % / 18 %) as compared with surgical palliation (p<0,01) with similar long-term results and therefore was recommended as preferred final palliation in incurable patients.

Based on the study results of 64 patients colonoscopy the use of brackish water “Longevity” solvent 15-20 % improvement in quality of preparation of the intestinal mucosa by colonoscopy when using traditional one-stage schemes with products based on macrogol, facilitates bowel cleansing in patients suffering from chronic constipation, and does not require increasing doses of drugs based on macrogol.

In order to justify the possibility of performing microsurgical restorative operations on the ileocecal valve 151 objects (21 dogs and 130 corpses of people) were examined. Two series of experiments were carried out: intraluminal sphincteroplastics of the bauhin’s valve by microsurgical technique was per-formed on 12 animals and traditional technique was used in 9 dogs. The restorative operation was made on the 8th day after creating the model of the ileocecal valve insufficiency. On the basis of the obtained data on the morphological characteristics, morphometrical parameters and microsurgical anatomy of the ileocecal valve a mode of intraluminal correction of the ileocecal valve insufficiency has been developed by using microsurgical methods. New findings on the dynamics of healing of the ileocecal sphincter in different terms after restorative operation by microsurgical technique were obtained, morphological and functional characteristics of the ileocecal sphincter in different terms after the operation were defined. The received data show that the use of microsurgical technique in per-forming the restorative operation on the ileocecal sphincter makes it possible to improve the results of the operation thanks to the restoration of sphincter and antireflux properties. The risk of development of incompetent sutures is minimized due to favorably proceeding reparative processes.

Introduction: Barrett’s esophagus (PB) was recognized as one of the most serious complications of gastroesophageal reflux disease, an obligate precancer with a high malignancy index: 20-30 %. The aim of the study was to analyze the literature data and the changed notions about Barrett’s esophagus. Materials and methods: the literature sources were selected using the TRIP Database information retrieval system for the UpToDate, DynaMed, PubMed databases. We selected 4 clinical guidelines and 4 systematic reviews and meta-analyzes, the analysis of which was presented in the article. Conclusion: It should be noted that up to the present time many people’s efforts are aimed at developing an «ideal» universal medical technology for diagnosis and treatment of patients with ambiguous diagnosis of Barrett’s esophagus.

Hiatal hernia is one of the most common variants of anatomical dislocation of the abdominal cavity elements. The diagnosis of this condition is based on the results of endoscopic and radiologic investigations. Indications for surgical treatment of hiatal hernias are resistance of gastroesophageal reflux symptoms for conservative management and the risk of its infringement. To increase the effectiveness of surgical interventions, prosthetic materials are used to correct of hiatal hole. The type of antireflux reconstruction depends on the gastroesophageal reflux severity and esophageal motility. Good long-term results of surgical treatment of hiatal hernias are found in 75-85 % of cases.