This review reflects current data on the possibilities of surgical treatment of patients with metastases of renal cell carcinoma in the pancreas in the aspect of complex therapy. The data obtained are ambiguous due to small patient samples, the extreme rarity of metastatic lesions of this localization and the ambiguity of approaches to surgical treatment. The prerequisites for performing duodenum-preserving pancreatic head resection as an operation that has a high potential of a favorable quality of life of patients in the long-term postoperative period.

Nonspecific ulcer colitis remains one and most complex problems in gastroenterology today. The chronic nonspecific diffusion inflammatory canker of slime and submucosal layer of a direct and large intestine is the cornerstone of this pathology that causes the clinical picture which is shown in the form of abdominal pains, tenezm, obstipation, intestinal bleedings, a frequent liquid chair with impurity of blood and pus. Also nonspecific ulcer colitis can be shown by various abenteric manifestations that causes certain difficulties in early diagnosis and treatments of this disease. Article narrates about the main strong points for the general practitioners and gastroenterologists facing this disease.

The aim: to focus on a relatively new and little-studied pathology of the colon-NSAID-colopathy, to show the similarities and differences in the clinical and endoscopic picture with ulcerative colitis. Materials and methods: comparison, based on the data available in the literature and own observations, using methods of endoscopic diagnosis, pathology of the colon with a similar clinical picture. Results: on the basis of the obtained and systematized data, key differences were formed, formulated in the form of a table for a more visual and rapid perception of information and recommendations for the differential diagnosis of NSAID-colopathy and ulcerative colitis were given. Conclusion: understanding the specifics and differential diagnosis of inflammatory diseases of the colon improves the quality of therapy of these pathologies.

Objective: to determine the dependence of autofluorescent staining of epithelial colon lesions, depending on the histomorphological structure. Material and Methods: Video colonoscopy using autofluorescence was performed in 1674 patients. The patients’ age was 58±13.9, men were 761 (45.5%), women 913 (54.5%). Epithelial lesions were detected in 269 patients (16%). Endoscopic examinations were carried out according to a standard procedure using Olympus video colonoscopes, GF-260. Results: It was established that the presence of AF staining in the purple color of the epithelial colon lesions, as a marker of dysplasia, can serve as an additional criterion in the complex indications for their endoscopic removal. Conclusion: The developed method of using autofluorescent endoscopy is simple to perform and allows obtaining data that have a differential value on the presence of dysplastic changes in the epithelial colon lesions.

Two groups of patients with chronic severe periodontitis and gastropathy: І (comparison group, n = 26) - under standard therapy; ІІ group (studied group, n = 22) - Remaxol is included in the standard treatment regimen. On admission and after 10 days of treatment, we studied the structural and functional state of periodontal tissues with the calculation of clinical indices, performed fibrogastroduodenoscopy with a biopsy of the gastric mucosa, followed by determination of lipid composition in its tissues and red blood cells, determined the content of H. Pylori, pepsinogen I and II, immunoglobulin A and E, malonic dialdehyde and diene conjugates, the activity of phosphalipase A2 and catalase. Chronic periodontitis was established to be accompanied by significant structural and functional lesions of the stomach (gastritis, erosion, ulcers). The role of membrane-destabilizing phenomena in epithelial cells of the gastric mucosa has been proved in the pathogenesis of gastropathy. Oxidative stress and phospholipase activity are involved in the development of these phenomena. The use of Remaxol in the treatment leads to a decrease in inflammatory necrotic processes in the mouth and stomach. The effectiveness of the drug is largely due to its ability to reduce membrane-destabilizing processes by decreasing the activity of lipoperoxidation and phospholipase A2, as well as reducing the acidity of gastric juice.

Objective. Analyze the relationship between the surgical treatment of the upper gastrointestinal tract (GIT) and the decrease in bone mineral density (BMD) by comparison with reference age data and the control group. Methods. The medical data of 20 patients were analyzed with various types of surgical interventions on the upper GI tract (main group): 8 patients underwent various types of pancreatoduodenal resections, 11 - stomach resections, including two according to Billroth II, one patient underwent antral stenting. The patients’ age ranged from 53 to 84 years old, the median one being 70 years old, 13 men and 7 women. Measurements of lumbar spine BMD by the method of asynchronous CT densitometry were carried out using native images of the abdominal cavity, without contrast enhancement. The control group consisted of 35 patients who underwent an abdominal scan, without cancer pathology and without indications of a decrease in BMD. The age in the control group ranged from 43 to 86 years old, the median one being 65 years old, 22 men and 13 women. A multifactorial regression model was built to analyze the influencing factors on BMD. Results. A statistically significant dependence of the IPC on three factors was revealed: sex (p = 0.015), age (p = 0.001), and the presence of surgery. It was shown that among the main group of patients, the value of BMD was lower on average by 12.3 mg/ml as compared with the control group (p = 0.027), this corresponds to a decrease Zscore -0,35 SD. Conclusion. A statistically significant decrease BMD in patients after surgical treatment of the upper GIT, relative to the control group. It can be assumed that the emerging malabsorption syndrome is one of the prerequisites for the development of osteoporosis or osteopenia. Asynchronous CT densitometry is an effective method for monitoring bone mineral density, which provides additional information regarding BMD in patients under examination.

Objective: to improve the diagnosis of gastroesophageal reflux disease and its complications. Materials and methods: clinical and endoscopic studies were performed on 1052 patients, 110 of them healthy, 722 - with gastric ulcer and duodenal ulcer, after Billroth II stomach resection, with a hiatus hernia, gallstone disease, etc., 210 children. Studied 100 macropreparations of the esophageal-gastric junction and 70 longitudinal histotopograms from patients who died from diseases not related to diseases of the gastrointestinal tract, histotopograms of 10 cases with esophageal adenocarcinoma and esophageal-gastric junction. Results: The location of the Z-line is individually variable, the range is limited to two levels: up to 40 mm above and 18 mm below the outlet of the cardia. The presence of a mucous membrane with a cylindrical epithelium in the distal esophagus is a variant of the norm. In the area of the Z-line in 70% of cases there is a duplication at a distance of 10 mm, consisting of a mucous membrane with a stratified squamous epithelium, covering the mucous membrane with the gastric epithelium. High Helicobacter infection of the mucous membrane with gastric epithelium was detected, its pre-neoplastic changes in adults (17.2%), in children (10.9%) and Barrett’s esophagus are often found in mild degrees of esophagitis, and there are also indirect signs of HP in the esophagus. Conclusions: The presence of a mucous membrane with a cylindrical epithelium in the esophagus up to 40 mm above the outlet of the cardia is a variant of the norm. In the area of the Z - line there is in 70% of cases duplication at a distance of 10 cm, consisting of a mucous membrane with a stratified squamous epithelium, under which there is a mucous membrane with a gastric epithelium, and a step biopsy is required to diagnose changes in it. The presence of HP in the mucous membrane of gastro-esophageal junction has indirect endoscopic signs, contributes to the development of pre-neoplastic changes of the mucous membrane, which in most cases are found in mild degrees of esophagitis, which requires antihelicobacter therapy.

Aim. The aim of the research was to perform an analysis of surgical complications of abdominal tuberculosis and to determine optimal surgical treatment methods. Materials and methods. A retrospective analysis of the treatment of 166 patients with surgical complications of abdominal tuberculosis was conducted: 60 HIV-negative patients of group I and 106 HIV-positive patients of group II. The patients underwent a comprehensive examination, which included diagnostic radiology, endoscopic methods, and the study of biological media for the detection of Mycobacterium tuberculosis. All patients underwent various types of urgent surgery. Results. Perforations of tuberculosis ulcers of the intestine were diagnosed in 71 (42.8%) patients, tuberculosis peritonitis in 50 (30.1%), acute intestinal obstruction in 26 (15.7%), intestinal bleeding in 8 (4.8%), tuberculosis spleen abscesses - in 11 (6.6%). Analyzing our experience in treating patients with abdominal tuberculosis, it can be said that surgical complications are twice as likely to occur in HIV-positive patients, but the spectrum of the incidence of surgical complications does not differ. Conclusions. The most frequent surgical complications of abdominal tuberculosis in both patients with HIV-negative and in patients with HIV-positive status are perforations of intestinal tuberculosis ulcers, tuberculosis peritonitis and acute intestinal obstruction, which lead to the development of severe surgical complications, causing the complexity of diagnosis and treatment and high mortality. The tuberculosis lesions of various organs and systems were detected in HIV-positive patients 2.3 times more often; tuberculosis is of a generalized nature, associated with hematogenous dissemination and is accompanied by severe surgical complications.

The aim was to optimize the method of endoscopic bougienage in common bile duct strictures using the oral choledochoscope. Materials: the analysis of 177 patients with bile duct strictures of the main group and 38 patients of the comparison group. The nature and history of bile duct strictures, as well as the possibilities and effectiveness of application the oral choledochoscope in the narrowing of strictures in difficult clinical situations have been studied. Results: the method proposed by us was applied in 5 patients, in complex clinical cases when, under X-ray control, it was not possible to hold the string conductor outside the stricture zone. Comparing the proportion of effective and ineffective minimally invasive interventions, a higher rate was observed in the main group by 12.1% (91.0%) than in the comparison group (78.9%) with a statistically significant difference in the proportions (p = 0.0329, t. e. p <0.05). Conclusion: the introduction of the bougienage method with the choledochoscope allowed a statistically significant reduction in the failure rate of minimally invasive treatment of common bile duct strictures in the main group of observables.

Malignant colonic obstruction is actual problem of emergency surgery. In various clinical situations it is possible to perform different interventions. Colorectal stenting is the favorite method of palliative treatment. However, the role of stenting in patients with curable or potentially curable tumors remains unclear. This literature review presents data from meta-analysis, randomized and cohort studies, as well as recommendations to determine the role of colorectal stenting as bridge to surgery

Rectal cancer occupies one of the leading places in the structure of mortality in both sexes, with the only radical method of treatment is surgery. For the planning of surgical treatment, it is important to assess the metastatic lesion of the locoregional lymph nodes, the presence of extramural lymphovascular invasion, which is an important predictor of recurrence of the disease, as well as an indicator of the early appearance of distant metastases. The effectiveness and reliability of preoperative staging of the low rectal cancer has increased significantly after the introduction into clinical practice of magnetic resonance imaging, as well as a comprehensive preoperative radiation examination of patients. The article is devoted to the problems of preoperative staging and determination of statistically significant relationships between the presence of extramural vascular invasion in cancer of the low rectal cancer and the presence of distant metastases, the identification of the correlation between T and N - stages of the tumor, their morphological types with diagnosed extramural vascular invasion.

The problem of high prevalence of fatty liver diseases is known today. The question of the diagnostic differentiation of non-alcoholic and alcoholic fatty liver diseases (NAFLD and ALD) has been studied in many studies, possible solutions have been proposed, but, to date, none of them are used in wide practice due to the presence of significant deficiencies in each method. At the same time, timely diagnosed diagnosis directly affects the quality and, often, the life expectancy of the patient. The review presents all modern methods of laboratory diagnostics that can identify differences between NAFLD and ALD, with an indication of the main known characteristics of each method.

Modern data on endoscopic and morphological factors for the prognosis of early gastric cancer (macroscopic type of tumor, its size and the presence or absence of ulceration, histological type and degree of differentiation of the tumor, immunophenotype, depth of invasion, the presence of cancer emboli in the lumen of lymphatic and blood vessels) are given. The indications for performance and criteria for the effectiveness of endoscopic surgical methods for treating early gastric cancer, recommendations for further patient management tactics are given.

Cystic neoplasms of the pancreas is a group of neoplastic changes in the epithelium of the ducts or parenchyma, which are the difficult diagnostic problems of modern medicine. With the improvement of diagnostic methods, the frequency of detection of incident cysts has increased. The article discusses the differential diagnostic characters, morphological features, and the potential for malignancy of pancreatic cystic neoplasms.

Colonoscopy has been established as the gold standard for the detection of colorectal neoplasms. Adenoma detection rate (ADR) is one of the most important quality indicator of colonoscopy, and, as it has been recommended by a European Society of Gastrointestinal Endoscopy (ESGE), the benchmark for ADR is 20%. However, ADR widely varies, and almost one fourth of polyps and adenomas are missed. Currently several techniques have been developed with the aim to improve the quality of colonoscopy. Among them there are image-enhanced endoscopy (IEE) and techniques or devices that improve mucosal observation. IEE includes chromoendoscopy and virtual chromoendoscopy (NBI, FICE, AFI, i-scan); among techniques which enable better observation of the mucosa there are add-on devices, such as transparent cap, Endocuff, Endocuff Vision, Endorings; and wide-angle colonoscopes (full spectrum endocopy - FUSE). In the literature review, these mentioned techniques and their effect on ADR are described.

Objective. The purpose of the literature review is to present the latest literature data on endoscopic resection of a laterally spreading colon tumor. Conclusions. Most non-malignant colon neoplasias can be removed by the endoscopic method. When removing LST, it is necessary to focus on high-quality endoscopic imaging, magnification, chromoscopy and narrow-spectrum endoscopy. LST resection should be carried out according to the accepted method. Before making a decision on endoscopic resection of neoplasia, all its characteristics should be carefully evaluated. The analysis of cases of incomplete removal and recurrence of formation is associated with a size of more than 40 mm, localization in the ileocecal colon, the characteristics of the patching pattern and the probability of invasion.

Aim: the unresolved problem with the large amount of treatment options for the achalasia cardia indicates the absence of a perfect treatment method. The large interest in peroral endoscopic myotomy, as in any innovation, leads to disregard of other treatment methods and the absence of an alternative. Therefore, attention to a simple, low-cost and effective way of dilating the cardia should again be drawn. Materials and methods. This article summarizes the results of 30 years of experience in treating functional obstruction of the cardia with endoscopic balloon dilation in 353 patients. The technical features of the intervention with the specially designed balloons fixed to the endoscope, as well as large-diameter wire-guided balloons are described in the article. Results. Criteria for assessing the end of endoscopic treatment of achalasia and cardiospasm are given. It is shown that the correct technique of the intervention gives good and satisfactory immediate results up to 95%, long-term - up to 80% of cases with 1 to 26 years remission. Conclusion: endoscopic balloon dilation is an equal, well-developed minimally invasive method for treating achalasia cardia and can technically be performed at any stage of the disease.

The aim was to assess the potential of the usage and efficacy of full-spectrum colonoscopy in children. Materials and methods: 22 children (1-17 years) were assessed with a full-spectrum colonoscope (FUSE system). Colorectal polyps were detected and removed in five of them. A new FUSE colonoscope has three cameras and allows a panoramic to 330 ° field of view. Results. With this full-spectrum colonoscope, endoscopists are able to view difficult- or impossible- to- view areas within the colon (“blind spots”), that allows to improve diagnostics of colorectal lesions. FUSE system helps in navigation within the colon. FUSE colonoscopy appears to be safe and efficient diagnostic and therapeutic method in children.

The interest of the above clinical case is that cholecysto-duodenal fistula, which arose against the background of cholelithiasis and caused high obstructive small intestinal obstruction by biliary calculi migrated from it, is a very rare complication of gallstones and was diagnosed at the preoperative stage. Patient B, 75 years old, was admitted to GBUZ “KKB No. 2” in Krasnodar on July 21, 2016 with a diagnosis of Cholelithiasis. Chronic calculous cholecystitis. Choledocholithiasis. High small bowel obstruction? The first step was performed diagnostic esophagogastroduodenoscopy. When endoscopy at the output level of the LDPC, along the back wall, a wall defect in the form of a cholecysto-duodenal fistula with visualization of the gallbladder cavity is determined. At the level of the lower horizontal branch of the duodenum, there are mobile multiple biliary concrements that completely overlap the lumen of the duodenum. It was decided to perform endoscopic mechanical litoextraction of these stones. With the Dormia basket probe, movable duodenal calculi were captured and removed. After deleting the mobile calculus data, we found a large calculus that completely covered the duodenal lumen. An attempt was made to electrohydraulic lithotripsy of this large calculus of duodenum. The calculus was fragmented. But when trying to hold an endoscope for calculus fragments, in order to capture them with a basket of Dormia, the ischemic wall of the duodenum perforated. The patient was transferred to the operating room, where laparotomy, duodenotomy, removal of the wedged calculus of the lower horizontal branch of the duodenum, suturing of the duodenum defect were performed. On day 12 after surgery, the patient was discharged from the hospital in a satisfactory condition.

Currently, non-alcoholic fatty liver disease (NAFLD) has taken a leading position in the structure of chronic liver diseases, making up 71.6% of their total number. Its prevalence is increasing, including among young people. The article describes a clinical case of the development of an early stage of NAFLD - non-alcoholic liver steatosis in a 28-year-old patient. The leading role of lifestyle modification in the complex therapy of NAFLD is noted. Positive clinical results with the use of the drug ursodeoxycholic acid are described. Identification of steatosis during ultrasound examination of the abdominal cavity requires clarification of its origin. In the absence of other possible causes and risk factors, the diagnosis of NAFLD becomes the most likely. The presented case demonstrates a favorable course of NAFLD, when a patient’s high motivation, combination of non-drug and medicinal methods allow to achieve good results.