In recent years, there has been a trend towards a steady increase in the incidence of colorectal cancer (CRC): the increase in the absolute number of patients with colon cancer from 2009 to 2015 amounted to 11.3%; rectal cancer - 9.9%. In the structure of mortality from malignant tumors of the KRR in our country takes the second place, second only to lung cancer. This fact is due to the fact, that the primary treatment of patients to the doctor advanced forms of cancer (III-IV stage) are diagnosed in 71.4% of patients with colon cancer and 62.4% in cases of rectal cancer. Such a late diagnosis is primarily due to the lack of an appropriate Federal screening program, as well as to the lack of awareness of medical workers in modern ideas about colonic carcinogenesis and precancerous changes in the mucous membrane of the colon.

Background: Genetic polymorphism of some inflammatory cytokines is associated with the risk of developing specific, H. pylori-associated diseases, including gastric cancer (GC). Aim: To study the genotypes and alleles frequencies of polymorphism 174G / C (rs1800795) of the IL6 gene and polymorphism -511C / T (rs16944) of the IL1B gene, as well as their association with biomarkers of atrophy in patients with GC in the clinical «case-control» study. Materials and methods: 80 patients with GC (45 mails and 35 females with an average age of 61.0 ± 13.4 years) from two medical centers were studied. In the control, DNA samples from 87 subjects were matched by sex and age from the base of the multicenter cohort study HAPIEE. DNA was isolated from venous blood using phenol-chloroform extraction. DNA samples were genotyped according to published methods. Serum samples were tested using a diagnostic kit for enzyme-linked immunosorbent assays to determine the levels of pepsinogen I (PGI), PGII, PGI/PGII ratios, gastrin-17 and IgG antibodies to H. pylori. Results: In the general group, association of polymorphisms of 174 G/C of the IL6 gene and the -511C/T gene of the IL1B gene with the GC was not found. However, in women, the frequency of the G/G genotype of the IL6 gene was 2 times higher in the group with G/C than in the control (p=0.03). In patients with corpus atrophy, the G/G genotype was revealed twice as often as homozygous C/C variant of the IL6 gene (p=0.002). In patients with GC, the genotype with a rare T allele (C/T + T/T) of the IL1B gene was significantly more frequent than the common homozygous C/C variant (p=0.03). The rare homozygous T/T genotype was significantly less frequent in patients with GC and no signs of corpus atrophy (PGI >30 μg/l): 11.3% vs 47.2% (C/T genotype) and vs 41.5% (genotype C/C) (p <0.001). Conclusions: The received data allow assuming the possible connection of studied polymorphisms with the formation of a cancer phenotype of the gastritis, which requires further study of their significance (weight) in the GC riskometry.

The purpose of the study: to evaluate the effectiveness of the use of transient liver fibroelastometry (TLF) in the determination of the stage of liver fibrosis (LF) in patients with non-alcoholic fatty liver disease (NAFLD) and obesity using XL- and M-sensors. Materials and methods: 110 patients with NAFLD were examined at different stages of the disease at the age of 29 to 82 years. The average BMI is 30.35 ± 5.35. The diagnosis is based on standard laboratory and instrumental data, assessment of the degree of steatosis depending on the stage of ultrasound and liver fibrosis on device for noninvasive determination of the degree of liver fibrosis and using XL and M sensors, using a puncture liver biopsy. Results: In patients with NAFLD and BMI more than 31.5 kg / cm2, when performing an M-sensor study, the number of studies with IqR> 30% (with low reliability) was more than 80%. In patients with NAFLD and BMI more than 31.5 kg / cm² when performing an XL-sensor, the number of studies with IqR> 30% was 4%. The sensitivity of the method ranges from 0.73 at the stage of F 2-3 on the METAVIR scale and 0.89 at F4, the specificity from 0.7 at F2-3 to 0.77 at F4. AUROC as a whole 0,8 that speaks about good reliability of a method. Conclusions: patients with NAFLD and BMI 30.35 ± 5.36 recommended to perform TLF using an XL-sensor. A BMI of 39 kg / m² or more is an absolute limitation for performing TLF.

Objective: to determine the possibility of screening for gastroesophageal reflux disease (GERD) by size and shape of the stomach gas bubble on the direct X-ray of the chest and abdomen. Methods and results. One hundred seventy-five radiographs of patients of different ages were analyzed by the random sampling method. The shape of the stomach gas bubble (SGB) was determined and its width and height were measured. Results. SGB was detected in all pediatric patients. It was absent in 18% of adults (16-64 years) and in 25% of the patients aged 65 years and older. In majority of patients fundus had a shape of a dome with the level of liquid content. In 6% of patients the SBG was deformed with an angular protrusion in the shape of the «bird beak» pointing in the direction of the spine. The more advanced was the age of a patient the more increase in volume of SBG we observed in the sagittal plane. In the direct projection, age had no significant influence on the average size of the SGB (except without SGB). There was a significant increase in the width of GBS in older children (7-15 years) compared to children aged 1-6 years. In adults, there was a tendency to have smaller width and height of SBG (P> 0.1). In elderly, we found a significant decrease in these parameters. Discussion. The size of the dome of SGB, which is a «trap» for the air, depends on the stability of its walls. In GERD the intraperitoneal portion of the lower esophageal sphincter is weakened and is opened either temporarily under the pressure, or permanently. In such cases, the dome is deformed with the formation of a corner protrusions, and reduced in size. Conclussion. The absence of GBS, or the decrease of its size, or the angular protrusion of its inner wall on the x-ray suggest the possibility of GERD. Further research is needed to determine the normal width and height of GBS.

Objectives: to evaluate the etiology of anastomotic ulcers (AU), being the sources of small bowel bleeding, using clinical, instrumental features and results of treatment. Materials and methods: From 14.02.2007 to 30.10.2017 from 213 patients, having applied to our hospital with suspected small bowel bleeding, AU were revealed in 8 (3,7%) pts (m-7, f-1, mean age 38,0±14,4 years, range 19-59). There were 7 (87,5%) pts. with obscure overt and 1 (12,5%) with obscure occult bleeding. Diagnostic procedures included videocapsule endoscopy (VCE) and balloon-assisted enteroscopy (BAE) in all of pts. VCE was performed in 6 (75,0%) pts, followed by BAE, which was ineffective in 2 cases. BAE was performed in all 8 pts: it was effective in 6 cases, including 2 pts without previous VCE. Results: Anastomotic ulcers were initially revealed, using VCE, in all cases, then - confirmed using BAE (4) and surgery (2); using only BAE - in 2 pts. Initial conservative treatment, recommended to 6 (75,0%) pts, was effective in 1 case; in other 5 cases surgery was performed because of persisted anemia and rebleeding episodes. Surgery at once was performed in 2 (25,0%) pts. After surgery and histology in 7 pts we revealed ulcers at the anastomotic area in 4 (57,1%) pts, in the middle of long blind loops area in 3 (42,9%) pts. Signs of ischemia and Crohn’s disease were not revealed. Suture material was detected in ulcer bases in 2 (28,6%) pts. All patients have been free of relapse (1-7 years). Conclusions: Using VCE and BAE gave the opportunity to reveal the source of bleeding in pts with AU, suffering for a long time. Having analysed surgery and histology results in 7 pts, we can suppose, that long blind loops, as well as suture material can lead to anastomotic ulceration in patients after SB resection. Further accumulation of clinical material is needed for complete analysis of etiology of AU.

The aim of the study was to analyze the results of inpatient treatment of patients with malignant colonic obstruction with the use of colorectal stents, and identify the factors associated the unfavorable result of treatment. Materials and methods. The study included 102 patients who, from December 2012 to August 2017, made an urgent attempt to stenting. Stenting was performed under combined (X-ray and endoscopic) control. Double coated and uncovered stents were used. Results. The clinical and technical success rate were 97.0 and 94.1%, respectively. The incidence of complications in the immediate postoperative period was 3.1%. Inpatient mortality rate was 6.1%. The duration of symptoms of colon obstruction is associated with the outcome of an unfavorable outcome. Conclusion. Colorectal stenting is an effective and relatively safe method of relieve of obstructive colonic obstruction of tumor origin. It is necessary to continue the study to assess the long-term outcome of treatment.

Aim: Modern technologies involve the use of minimally invasive interventions in the treatment of choledocholithiasis, however, despite the improvements in endoscopic techniques, the total number of early complications is still at a consistently high level and is 0.8-20%, with mortality rates of 1.5-2%. Sphincter of Oddi insufficiency, stenosis of major duodenal papilla, the recurrence of choledocholithiasis are most common complications at late stages after the endoscopic papillosphincterotomy. Еndopapillary interventions are the “gold” standard of choledocholithiasis treatment and increasing their safety requires further study and development. Result: A “Method of endoscopic treatment of choledocholithiasis and prevention of postmanipulation complications” (Patent of Russian Federation for invention № 2644307 dated by 08.02.2018) was devepoled. Thirty seven patients with choledocholithiasis were treated according to the proposed method during the period of 2016-2017. Early postoperative complications were not observed. Transient amylasemia was revealed in 12 patients (32%). Signs of sphincter of Oddi insufficiency were found in 1 of 7 patients (14.3%) who underwent hepatobiliscintigraphy. Conclusion: The developed method of endoscopic treatment of choledocholithiasis allows to prevent the development of early and late postmanipulation complications.

Aim: To evaluate the factors affecting the development of acute biliary pancreatitis by incarcerated calculus of the terminal portion of the common bile duct. Materials and methods: The results of treating 60 patients with incarcerated calculus of the terminal portion of the common bile duct after endoscopic intervention on the major duodenal papilla were analyzed. Results: Patients were divided into two groups: with acute pancreatitis (group 1, n = 34) and with no changes in the pancreas (group 2, n = 26). To compare the groups, laboratory, and endoscopic results were analyzed. According to case history, 26 patients (76%) from group 1 and 2 patients (8%) from group 2 had chronic pancreatitis. There was also a decrease in the development of acute pancreatitis to 11.8% of cases in patients who had undergone early (less than 6 hours) endoscopic papillotomy and lithotomy. Conclusion: It is established that the presence in the history of chronic pancreatitis, cholelithiasis, and concomitant purulent cholangitis is a prognostic criterion for the development of acute biliary pancreatitis. It is established that acute biliary pancreatitis may develop due to chronic pancreatitis, cholelithiasis, and concomitant purulent cholangitis in history as well as due to late (more than 6 hours) decompression and sanation of bile ducts.

Article is devoted to the analysis of compliance of endoscopic and histological studies of different forms of chronic gastritis. Results of inspection of 3593 pa-tients with chronic gastritis are studied in long dynamic observation. The analysis of endoscopic signs in a descriptive picture of chronic gastritis irrespective of prescription of a disease has revealed three main general signs: diversity, unevenness, foci of atrophy of gastric mucosa. Analysis of the microscopic picture showed the same atrophic-hyperplastic processes of varying degrees of severity in different forms of chronic gastritis (hypertrophic - nodular, verrucous, polypoid, small and large focal atrophic gastritis). There is high degree of correlation between the endoscopic and microscopic features. The scheme of development and interpretation of chronic gastritis is offered. Use in practice of the endoscopist the conclusion “chronic subatrophic gastritis” to a stage “chronic atrophic gastritis” is proved.

Purpose: Improve treatment outcomes in patients with cholelithiasis complicated by choledochal-tiasa, through the introduction and improvement of the videoendoscopic technology. Materials and methods: 97 patients with cholelithiasis complicated by choledocholithiasis and/or stenosing duodenal papillitis is divided into two homogeneous groups. In the main group (n=47) of the patients operated using laparoscopy, in control (n=50) - laparotomy. Results: the Average duration of surgery in both groups were not significantly different. The level of postoperative pain in patients of the main group was significantly lower than the comparison group. Light postoperative complications observed were given in 17 cases of the main group (36.2%) and in 24 patients in the control group (48.0 per cent). In 1 patient of the main group diagnosed subhepatic abscess, developed shenny by drainage under ULTRASOUND control. 3 patients of the control group, postoperative wound suppuration. In each of the groups, there was 1 case of insolvency of choledochojejunoanastomosis. Conclusions: Laparoscopic access has no effect on the duration of operation of the radio and can significantly reduce the intensity of postoperative pain. Often, the early postoperative complications after laparoscopic choledocholithotomy-MII does not exceed the frequency of complications after choledocholithotomy performed laparoscopy-volume access.

The purpose of the study: Evaluation of the effectiveness of the using of levomenthol solution in the lumen of the colon to improve visualization of pathological changes during total videocolonoscopy. Materials and methods: We examined 2 groups of patients according to 75 people. The first group was examined with using of levomenthol solution, which was insert in the channel of the endoscope into the lumen of the sigmoid colon during the colonoscopy. The second group was the control, the patients in this group underwent standard colonoscopy. Results: In the group surveyed with the help of drug exposure, it was discovered 56 neoplasias(44 of them size up to 0.5 cm). In the control group identified 28 lesions (11 of them size up to 0.5 cm). In the right part of colon in the two groups was found 30 different histological structure, in the left - 54 neoplasia. The time spent in the videocolonoscopy with the use of levomenthol, amounted to 14.05±3,03 min: time to the dome of the cecum is 5.1 ± 3,8 minutes, during breeding of the endoscope of 8.95 ± 2,67 min. In the control group, these data were 16.06±5,09 min, 6,3 ± 2,6 min and 9,76 ± 4,29 min, respectively. Conclusion: The application of levomenthol solution can significantly increase the efficiency of detecting epithelial tumors of the colon. In terms of levomenthol solution was detected in 4 times more the smallest polyps than standard colonoscopy. Time periods spent in study, was significantly lower in the group of levomenthol, compared to standard colonoscopy.

The interplay between chronic inflammation and tumorigenesis has been widely discussed. Chronic inflammation induces premalignant changes in tissues (tissue metaplasia, atrophic changes, etc.) and promotes local tumor invasion, metastatic spread and tumor progression. Chronic inflammation can also induce changes of the DNA, promoting accumulation of pro-oncogenic mutations, which results in development of specific tumor environment as well as selection of chemo- and radioresistant tumor cells. Suppression of innate and acquired immunity caused by chronic inflammation also promotes tissue changes, increasing the likelihood of tumor development. The synergistic action of all above mentioned factors is implicated in development of multiple malignant neoplasms in a variety of organs. In this article the intricate interplay between chronic inflammation and tumorigenesis in various organs and organ systems is discussed. The understanding of these processes is of greatest importance, especially in gastroenterology, caused by relative prevalence of inflammatory bowel diseases and peptic ulcer disease. Further understanding of these processes can help further improve the diagnostic and treatment approaches to malignant tumors, as well as prevention of inflammation-induced tumor progression.

Gastric cancer occupies the 5th place in the structure of total cancer incidence worldwide. In 2015, Russia diagnosed about 35 thousand new cases of rye. Mortality from this disease and its complications remains high. Numerous studies conducted in different countries of the world have shown that the dominant role among all anatomical forms of gastric cancer is played by endophytic tumors (more than 65% of all detected cases), which are the most difficult to diagnose. Even with the latest diagnostic tools, it is often not possible to obtain enough information to clearly speak in favor of the existence of an intra-neoplastic process. Optimization of diagnosis of gastric cancer continues to be one of the important problems of Oncology. The absence of changes in the mucous membrane, usually makes it impossible to determine the boundaries of the standard endoscopic and radiological methods. The possibilities of standard ultrasound examination of the stomach wall, and especially the esophagus wall, are also limited. The most promising in terms of complex diagnosis of intramural and lymphogenic prevalence of tumor process is the use of endoscopic ultrasound.

Aim. To investigate the impact of infusion therapy with Remaxol® on liver function in patients with intrahepatic cholestasis in chronic liver diseases (metabolic, drug, alcoholic hepatitis, chronic hepatitis B, C, autoimmune hepatitis, primary biliary cirrhosis, cross autoimmune syndrome). Subjects and methods. 102 patients aged 25 to 80 years, with intrahepatic cholestasis syndrome with chronic liver diseases different etiology were examined. Patients of the main group (n = 68) in the complex therapy received an infusion hepatoprotector Remaxol® daily intravenously drip 400.0 ml once a day for 11 days. Patients of the comparison group (n = 34) in the complex therapy received lyophilizate to prepare a solution for intravenous and intramuscular administration of ademetionine 400 mg diluted in the original solvent. Results. Infusion therapy with Remaxol® for chronic liver diseases of various etiologies (viral, metabolic, toxic, autoimmune), with intrahepatic cholestasis promotes: regression of the main clinical syndromes (pain abdominal from 68% to 25%, dyspeptic, 80% to 26% asthenic from 92% to 52% (p <0.05), cholestatic from 100% to 24% (p <0.05). A statistically significant difference in the dynamics of cholestasis was demonstrated by the change in the GGT value between the groups studied: the relative values of reduction in GGT levels in the patients of the main group were 38% compared to 19% in the comparison group patients (p <0.05). In the patients of the main group, the level of total cholesterol was reduced in dynamics from 10,10 ± 1,20 to 6,23 ± 0,31 mmol/l (p <0,001); improvement of protein-synthetic liver function; an increase in the absolute number of lymphocytes from 1.05 ± 0.08 x 109/l to 1.53 ± 0.06 x 109/l, (p <0.05). Conclusion. The effectiveness of Remaxol® in patients with intrahepatic cholestasis indicates the role of hepatoprotective, anticholestatic, cytoprotective effect of antioxidant therapy in restoring the functional status of the liver, immunoreactivity cells, as well as the presence of a lipid-regulating effect of the drug.

The removal of the laterally spreading tumor is a radical method of its treatment; it is necessary to control the completeness of LST removal using ZOOM and destruction of residual tumor tissue by argon-plasma coagulation to prevent recurrence of the tumor.

Aim: The inflammatory myofibroblastic tumor (IMT) is rare and has an intermediate malignancy in terms of local invasiveness. There are pulmonary and extrapulmonary forms that are rare to be come across. Among extrapulmonary forms, biliary lesion occurs in isolated instances. Due to the rarity of the disease, we provide our own clinical observation. In a 35-year-old patient various instrumental methods showed the formation in the distal common bile duct (CBD), which manifested the painless form of jaundice. The presence of tissue mass in the distal CBD is often associated with malignant neoplasms. One of the informative instrumental techniques turned out to be endosonography and endoscopic retrograde therapeutic and diagnostic interventions on extrahepatic bile ducts with biopsy sampling. Due to the rarity of the disease and the precaution regarding the malignant origin of the neoplasm in the distal CBD, the patient underwent a surgery. Histological and immunohistochemical data confirmed the inflammatory myofibroblastic tumor.

Introduction. Iatrogenic bile duct injury continues to be one of the most important clinical problems in surgery. Due to the development of non-surgical ways of treatment, bile duct injury is mainly managed endoscopiccally. Materials and methods. 53 y. o. female patient was admitted in April of 2015. According to the anamnesis - laparoscopic cholecystectomy in February 2015, complicated with the injury of the right hepatic duct (clipped and cut). MRCP- right hepatic duct is blocked by the confluence. 27.04.2015 ERCP, ERS, ballon dilatation of the stump and placement of the 7Fr stent in the right hepatic duct. Results. Until May 2016 the patient had 3 restenting operations on the right hepatic duct with the bigger stent each time (8.5, 10 Fr). The last ERCP was finished with the removal of the plastic stent. During the contrast study the diameter of the duct in the structure area was 4 mm. The patient is monitored with no relapse for 1 year and 6 months. Conclusions. Minimally invasive endoscopic treatment of iatrogenic bile duct injuries with a step by step stenting is more preemptive then open reconstruction surgical procedures.

In the autumn of 1908, the Assembly of the Karolinska Nobel Institute in Stockholm awarded the prize in physiology and medicine to two of the most prominent exponents of an alternative view of the nature of immunity - Russian biologist Ilya Ilyich Mechnikov. Deputy Director of the Pasteur Institute in Paris, and German bacteriologist Paul Ehrlich - Director of the Royal Institute of experimental medicine and the Institute of chemotherapy. George Speer in Frankfurt am Main. Below is a translation of the text of the invitation of the Nobel Committee addressed to the Russian winner of the prize - I. I. Mechnikov and signed the Executive administrator of the Nobel Fund, count K. A. Morner