Aims: To explore the spectrum of risk factors associated with hepatocellular cancer (HCC) in Russian Federation, their prognostic significance for overall survival (OS). Methods: retrospective trial of 380 HCC cases referred to Russian Cancer Research center n. a.N.N.Blokhin between 2005 and 2015. Results: We observed viral hepatitis in 221 (58,2%) pts; liver cirrhosis 203 (53,4%) pts. The most (n=94 from 105 pts) HBs+ cases were men, with cirrhosis in 64,8%. There was men’s (n=82) prevalence in HCV patients (n=114, 30%) also, mostly complicated with cirrhosis (n=100, 87,7%). We didn’t find any HCC-driven risk factors in 59 pts, including 28 pts with fibrolamellar carcinoma. There were 33 pts with alcohol intake as a risk factor. The main risk factors for 66 pts were signs of metabolic-associated diseases. HBV+ (p=0,041, HR=1,36), alcohol intake (р=0,0001, HR=1,75) and smoking (р=0.009, HR=1,52) were significant for OS. Diabetes mellitus, (p=0,03; HR=1,62), TNM stage (p<0,001; HR=1,42), АFP level (p=0,001) and male gender (p=0,024; HR=1,82) negatively correlates with OS worsening. Conclusions: Less than 60% of Russian HCC pts were HBV/HCV carriers or cirrhotic. HBV+ and HCV+ (27,6% and 30% pts); metabolic disorders (17,4%) and alcohol intake (8,7%) were predominant risk factors for HCС We didn’t observe significant OS difference between viral- and nonviral-associated HCC.

Aim: retrospective analysis of the results of stenting versus surgical gastrostomy in patients with malignant dysphagia. Material and methods: 172 patients underwent endoscopic stenting (107) or surgical gastrostomy (65). Level of stenosis: esophagus (70/48), gastric cardia (32/16), esophagogastro- or esophagojejunoanastomoses (5/1). 109 self-expanding metal stents were implanted in 107 patients; 63 Cader and 2 Witzel gastrostomies were performed in surgical group. Results: Stents were successfully inserted in all patients. Early complications were observed in 11 (10,3%) patients after stenting and in 10 (15,4%) after surgical palliation, p=0,2246. In-hospital mortality was 4,7% (5 patients) after stenting and 33,8% (22 patients) after gastrostomy, p<0,0001. Mean hospital stay was 13 days (quartile range 9-17) in stenting group and 15 days (quartile range 12-20) in surgical group, p=0,0040. There was no statistically significant difference in long-term results, neither in late complications (p=0,2212), nor in survival (p=0,0829). Conclusion: Endoscopic placement of self-expanding stents is an effective method of restoration of oral intake in patients with malignant dysphagia. Stenting is associated with equal rates of early and late complications, lower mortality and decreased in-hospital stay as compared with surgical gastrostomy, and therefore may be recommended as a final palliation in inoperable patients.

For 3 years at the Research Institute of Emergency Care by NV Sklifosovsky received 174 patients with clinical bleeding from the lower gastrointestinal tract. The first group included 76 patients (43.7%) with confirmed at colonoscopy bleeding, the second - 98 patients (56.3%) with no signs of bleeding. Research has shown that the structure of colonic hemorrhage in recent years has changed. If you have previously most often the source of bleeding is cancer and colon diverticula, now the leading source of bleeding is erosive or hemorrhagic colitis. Endoscopic hemostasis was performed in 5.2% of patients, and electroexcision of the polyps - at 9.2%.

Background. Endoscopists, surgeons and gastroenterologists have emphasized the importance of bleeding from oesophageal varicose veins, stomach and duodenum peptic ulcers and malignancies of this region, but less attention has been paid to the role of gastric erosions. Upper gastrointestinal bleeding (UGIB) may happen not only due to primary pathologies of UGI organs but also in case of different concomitant non-oncological and oncological pathologies. Possibilities of autopsies are the detection of real cause of death and misdiagnosed cases with gastrointestinal bleeding. Aim of the study. To analyse UGIB autopsy cases with different co-morbidities. Methods. We have investigated 120 cases of death from UGIB during the period of 2013-2014. Clinical information and laboratory analyses were obtained from the hospital electronic database. Pathology protocols and histological specimens stained with haematoxylin-eosin were analyzed. Diameter, depth and the total area of erosions were evaluated. We focused as well as on the site of death of the patient: whether it happened in hospital or outside it. Risk factors for UGIB were counted by Rockall numerical scoring system but Forrest scale was used for bleeding evaluation. Results. Patients were divided into two groups: 1) the patients, who died of profuse bleeding in connection with the upper digestive organ pathology (n=84), 2) the patients with bleeding developed mostly from erosions as a different disease complication (n=36). The main causes of fatal bleeding of I group persons were: gastric ulcer -38.1%, duodenal ulcer -11. 9%, oesophageal varices -30.9%. 28% of patients had such co-morbidities as: liver steatosis, different localization atherosclerosis and chronic forms of coronary heart disease, chronic pulmonary emphysema and nephrosclerosis. Rockall score was 4. Main illnesses of the II group of patients in case of secondary bleeding from gastric erosions were general atherosclerosis, cardiac pathologies with cardiac failure, chronic pulmonary diseases and non gastric malignancies. In contrast, the duodenal erosions were mostly found in chronic alcoholics with simultaneous pancreas and liver damage. Number of erosions in the stomach and duodenum ranged from 7 to 20. The average value of erosion diameter was 4.7 ± 1.3 mm. Rockall score was 8. Gastric and duodenal tissue tests confirmed the diagnosis of hemorrhagic erosive gastritis and duodenitis. The main diagnosis in this group of patients was correct in 84% of cases, but clinical information about gastric or duodenal bleeding was very insignificant.100 ml to 1.5 litres of blood was found in the stomach in both groups of patients. 29% of all patients died at the stage before hospitalisation. 48% of the patients were in the hospital from a few hours to 1 day. Conclusion. The improvement of the diagnostics of UGIB restricts delays in hospitalization, people low level of responsibility for their own health and insufficient information from family doctors about the patient background chronic diseases.

The aim of this study was to evaluate the morphological changes in the duodenum at acute biliary pancreatitis and after cholecystectomy and their influence on the frequency of EPST use at acute biliary pancreatitis. Materials and methods. Multicentre cohort study. A retrospective analysis of medical records of 535 patients with proven biliary pancreatitis from 2007 to 2013. Men - 212 (39.63%), 323 women (60.37%). The average age of 54,83 ± 14,17. The prospective study in 2013-2015 included similar 100 patients, mean age 59,27 ± 16,66 years. Duodenoscopy performed in all patients during the first 4 days. All of these patients underwent biopsy of duodenal mucosa near the papilla Vater. For comparison, 34 morphological studies performed of zone papilla Vater in patients with cholelithiasis after papillotomy. 28 women (82.3%), 6 males (17.7%) aged 25 to 82 years. Statistical analysis performed using the software Statistica 6.0 and SPSS19.0 Results. Frequency of EPST at acute biliary pancreatitis was 16.9%. In a retrospective analysis of the most significant causes of EPST were papillitis (φ = 0,950), functional stenosis of papilla (φ = 0,643), cicatrical stenosis of papilla (φ = 0,299) and obstruction of papilla by stone (φ = 0,299). In a prospective study dominated cicatrical stenosis of papilla (φ = 0,783) and obstruction of papilla by stone (φ = 0,446). Morphological studies of duodenal mucosa showed significant dependence of expression of morphological changes from the severity of acute biliary pancreatitis. Morphological assessment of papillae revealed the prevalence of chronic inflammatory changes, but the frequency of involvement in the inflammation of the deep layers were similar (18% vs. 15%). Conclusion. Frequency of duodenal inflammatory changes and inflammatory changes of papilla are connected among themselves. Endoscopic signs of duodenitis and papillit with expansion of a longitudinal fold demand early correction.

The aim of the study is to present an endoscopic ultrasound variety of esophageal cysts as a cause of diagnostic difficulties. Between 2005 and 2015 endoscopic ultrasonography (EUS) was performed in 31 patients with fluid intramural lesion of esophagus (22), stomach (5) and duodenum (4). It was found that intramural cysts can be located in any layers of the esophageal wall. Furthermore they can have the unusual echo-structure, which can lead to wrong conclusions. EUS should be included in the modern algorithm of examination of patients with so-called upper submucosal lesions. FNA may be performed if necessary.

Since October 2015 we have started to use contrast-enhanced endoscopic ultrasound (CE EUS) in some patients, among them there were two patients with insulinomas. One patient with unknown origin hypoglycemia was interesting from the diagnostic viewpoint. The laboratory diagnostic problems were related to the fact that the tumor almost did not produce insulin. Just detecting hyperproinsulinaemia we managed to prove the endogenous hyperinsulinism. At topical diagnosis CE EUS was the only one method detected hyper-vascularized tumor in pancreatic isthmus. The tumor was successfully enucleated laparoscopically. Immunohistochemical study confirmed neuroendocrine tumor with predominant production of proinsulin. Normoglycemia was defined at two-month follow-up

Study aims. Recently the possibility of LES tonus increasing by the means of implantable electrical stimulator was described. Although this method is already used in clinical practice, optimal parameters of LES electrical stimulation are still unknown. The goal of this study was obtaining of clinical data regarding effects of different modes of electrical stimulation on LES tonus. Methods. LES electrical stimulation using external pulse generator was assessed in 9 patients with severe GERD and decreased LES tonus. These patients underwent standard laparoscopic antireflux intervention with additional insertion of 2 temporary electrodes at the level of gastroesophageal junction. Three sets of parameters were studied: 1) low-frequency, long pulse (375 ms pulses, 5 mA at 6 pulse/min); 2) high-frequency stimulation (0.3 ms, 5 mA at 20 Hz); 3) high-frequency at 40 Hz (0.3 ms, 5 mA). High resolution esophageal manometry was used to assess changes in LES tonus. Results. Values of LES resting pressure and integrated relaxation pressure (IRP) were significantly different between prestimulation and poststimulation periods. The low-frequency, long pulse stimulation produces improvement of esophagogastric junction relaxation in the poststimulation period. Patients stimulated with the second and the third sets of parameters demonstrated moderate relaxation of LES during the stimulation period and considerable increase of sphincter tonus in the poststimulation period. Conclusions. Electrical stimulation of LES produces changes in its tonus. Modifications of LES function during the stimulation and after the stimulation period depend on frequency and pulse width. Further clinical studies are necessary for selection of optimal stimulation parameters, which can be applied in the treatment of GERD.

The aim of the study was to test effectiveness and safety of cold snare polypectomy in small colonic polyps ≤8 mm in size. Method. In all, 148 consecutive patients with 308 small colorectal polyps were treated with cold snare polypectomy (CSP). Results. The average polyp size was 5.2±1.8 mm. 93.6% of polyps have been retrieved. Lost polyps were smaller then retrieved ones 3.8±1.5 mm vs 5.3±1.7 mm (р=0,0002). R0 resection has been achieved in 88.9% of cases. Serrated morphology was the only risk factor for R1 resection (р=0,008). There was no perforation or delayed bleeding. Intraprocedural bleeding was rate was 1.6% Conclusion. The data show that the CSP technique is safe and effective for small polyp removal.

As it is known, Doppler ultrasound is an effective method for the diagnosis of cirrhotic liver disease. This method allows visualization of the structural features of the liver, as well as to assess its hemodynamics in various pathological conditions. It is characterized by the relative simplicity and affordability. According to the reference data, the ultrasonic Doppler blood flow portal is considered to be the “gold” standard for the diagnosis of liver cirrhosis and portal hypertension. Based on the foregoing, we set a goal to study through experimental research the effectiveness of various methods of transplantation of stem cells to the liver for the hepatic hemodynamics upon simulated cirrhosis. We transplantated the cultured autologous mesenchymal multipotent stem cells to the liver in intrahepatically paracentetic, transportal and transarterial manner. Studies have shown that intra-arterial stem cell transplantation was the most efficient in comparison with intraparenchymal and transportal methods. The advantages of this transplantation method are primarily manifested themselves by comparative decline of the portal stagnation rates for 8 weeks of the treatment, as well as a decrease in the resistance index in the hepatic artery.

The purpose of this research is to study the effectiveness of ursodeoxycholic acid (Ursosan) in patients with different forms of echographic biliary sludge (BS) and its outcomes in the three-year follow-up period. The study included 68 patients with BS (men - 26, women - 42), aged 18 to 65 years. The diagnosis of biliary sludge was set in 52 patients at the hospital examination in specialized departments (gastroenterology and general therapy), and in 16 patients on an outpatient basis, using modern methods of research: clinical, laboratory, ultrasound and the fractional chromatic duodenal probing. In this case, it is shown, that daily dose and duration of therapy depends on the echographic form of the disease. For the first time, the BS outcomes were analyzed during three years of follow-up, and compared with the control group of 16 patients received only symptomatic treatment. It was found that administration of the short 30 day courses of Ursosan therapy 500 mg a day, twice a year, allow 100 % prevention of the BS recurrence, and the formation of gallstones. Therefore, it can be considered an effective long-term strategy.

The purpose of this study was to investigate the effect of infusion therapy hepatoprotector remaxol on the functional state of the liver in liver cirrhosis in the outcome of chronic hepatitis (HBV, HCV), alcoholic, toxic, autoimmune, metabolic origin) for 11 days care. To do this, we examined 130 patients from 25 to 80 years with a diagnosis of chronic (viral (B, C), autoimmune, toxic, alcoholic, non-alcoholic) Hepatitis, cirrhotic stage, Child-Pugh A-C. Patients of the main group (n = 80) in the complex therapy received remaxol daily intravenously at 400,0 ml of 1 times a day, for 10-11 days. Patients comparison group (n = 50) on the background of crystalloid infusion therapy ademetionine received 400 mg per day, (lyophilisates for solution for intravenous and intramuscular reference, diluted in the original solvent) for 10-11 days. It was found that the inclusion in the scheme of complex treatment remaxol in patients with liver cirrhosis of various etiologies (HBV, HCV), alcohol, toxic, autoimmune, metabolic) improves the functional state of the liver: decrease the severity cytolysis syndrome, cholestasis, reduced manifestations of hepatocellular insufficiency, reduce the severity of hepatic encephalopathy, providing cytoprotective effect relative to peripheral blood cells (leukocytes, lymphocytes, platelets) due to membrane stabilizing, antiholestaticheskogo, cytoprotective effects of the drug. The results show the positive effect of therapy remaxol with cirrhosis of the liver of different etiology manifestations of hepatocellular insufficiency and hepatic encephalopathy.

Aim of study. To examine the possibility of adjuvant therapy in the treatment of autoimmune hepatitis. The theoretical background and the existing research on the use of hepatotropic drugs in autoimmune hepatitis have been considered. We discuss the situation when the therapy of autoimmune hepatitis can be supplemented by non-conventional medicines. It must be assumed that the treatment of autoimmune hepatitis should not always be limited to immunosuppression schemes, and in some cases may be enhanced by drugs that provide additional effects. The most promising agents for adjuvant therapy of autoimmune hepatitis are ursodeoxycholic and glycyrrhiziс acids.

Aim of the study. Pay attention endoscopists doctors, surgeons, gastroenterologists at the opportunity to meet in practice a rare congenital anomaly - the membrane of the prepiloric part of the stomach. Material and methods: Submitted the patient B., 20 years old, who underwent clinical, endoscopic and radiological studies of the upper gastrointestinal tract. Results: Patient B., during videoezofagogastroduodenoskopi found in the membrane of prepiloricly department with up to 9x5 mm hole in the center of the membrane with a normally functioning gatekeeper, which is confirmed by R-logicall. The treatment of H. pylori-associated gastritis was used. Conclusion: The presented a rare case prepiloricly orifice greater than 8 mm indicates the possibility of drug treatment the gastritis without breaking the evacuation function of the stomach, without resorting to surgery.

Solid pseudopapillary neoplasm (SPN) - rare tumor of pancreas of low malignant potential, occurs most frequently in young women and has a favorable prognosis. There is a case report of SPN at 20 years old female and literature review.

Presented by clinical observation: cardiospasm relapse after surgery performed for esophageal achalasia. The difficulty in interpreting X-ray pictures in the classic X-ray examination. The modification of the classical method of X-ray studies of the esophagus without complicating the technology research time and increase appreciation .

Gastrointestinal stromal tumors (GIST) are related to the group of rare gastrointestinal tract tumors with the mesenchymal origin and have their own morphological and immunnogical picture. The incidence of GIST is 10-20 observations per 1 000 000 population per year. About 5000-6000 new observations are recorded In the United States annually, 2000-2500 cases - in Russia. The average age among patients with GIST are primarily women 55-65 years old, rarely under the age of 40 years [2,3,4]. The most frequent GIST localization is 60-70 % in stomach and 25-35 % in small intestine [1,2]. Diagnosis of GIST includes a complex of Fibrogastroduodenoscopy, Ultrasonography and SKT examinations. Verification of GIST should be carried out under the results of the biopsy [4,5,7]. Treatment of patients with this type of disease involves a combination of surgery and chemotherapy.

Obtaining an eponym for one’s academic literature is regarded as one of the greatest honours: “Eponymity, not anonymity, is the standard” (Merton, 1973). To be exact, we will specifically look at 7 venous eponyms of gastrointestinal tract by analyzing names of the scientist (of the eponyms), their contribution to medicine. This article will provide an anatomical description as well as clinical implication of each of the eponyms.

The report of plenary session of the gastroenterological scientific society of Russia and scientific-practical conference dedicated to the 100th anniversary of the Acad. E. A. Wagner Perm State Medical University, scientific and practical school for gastroenterologists and therapists