The working environment is forming from the organizational conditions, motivation and the willingness of employees to fulfill their duties in the best way on the one hand, and is determined by the team ethical standards, on the other hand. Risks associated with the working environment are composed of compliance risks associated with ensuring compliance with legal requirements for labor protection and regulation, ensuring of infectious safety, as well as risks associated with the physical and psycho-emotional status of medical workers, determining the impact of the “human” factor on the work results. The purpose of this review article is to identify the risks of the working environment in endoscopy, as the first stage of risk management, in order to be able for further assessment of their impact on the safety of medical activities in endoscopy, as well as to identify the ways to reduce or eliminate these types of risks. The article includes the following relevant sections: 1. Compliance risks in endoscopy, as a part of the modern healthcare risk-management system—general questions. 2. Risks of the work environment in endoscopy in the conditions of epidemiological threats associated with a new coronavirus infection SARS-CoV-2 (COVID-19). 3. Risks of the work environment tips and tricks associated with the psychosomatic status and professional burnout of medical personnel in endoscopy.

This review presents a systematization of the literature on the nature of intestinal involvement in the pathological process in COVID-19; discusses the role of the “gut-lung axis” phenomenon in the implementation of the infectious process, provides an algorithm for choosing safe drug therapy in patients with inflammatory bowel diseases, and analyzes risk factors for antibiotic-associated diarrhea.

Purpose of the study. Clarification of indications, assessment of technical aspects and results of intraoperative intraluminal endoscopic assistance in patients with diseases of the gastrointestinal tract, respiratory tract and in cardiosurgical patients.

Materials and methods. Intraoperative intraluminal endoscopic assistance was performed for esophageal diverticula (41), gastroesophageal reflux disease and its complications (32), cicatricial stenoses and tracheal neoplasms (28), gastrointestinal tract neoplasms (17), and a mismatch between the diagnosis of the sending organization with intraoperative data (9) and for the anastomoses control (5). Intraoperative sanation tracheo-bronchoscopy with the definition of “background” flora was performed in 60 cardiosurgical patients with chronic diseases of the bronchopulmonary system.

Results. The indications for performing the intraoperative intraluminal endoscopic assistance have been specified taking into account the impact of the study on the surgical course and scope, the method of anesthesia and the tactics of further treatment. Various aspects of the formed fundoplication cuff, completeness of diverticulum resection, and suture tightness were assessed. In a number of patients, the localization of neoplasms and stenoses was clarified, which affected the definition of the resection boundaries. In a number of cases, intraoperative intraluminal endoscopic assistance allowed reducing the average time of intervention and helped to minimize complications.

Conclusion. Intraoperative intraluminal endoscopic assistance has its own peculiarities of execution, requires experience in data interpretation, requires a clear coordinated work and communication between the endoscopist, anesthesiologist and surgeon. In general, intraoperative endoscopy improves the results of surgical treatment and prevents complications.

Purpose of research. Evaluation of direct results of surgical treatment of patients with cancer localization in the middle and lower ampullary rectum using laparoscopic and open methods. Materials and methods: a retrospective analysis was performed on 221 patients who underwent anterior and low anterior rectal resection. Results. Independent risk factors for failure of low colorectal anastomosis were determined. Laparoscopic treatment of rectal cancer with total mesorectumectomy does not lead to an increase in the number of intra—and postoperative complications. Laparoscopic mesorectumectomy is a priority method in comparison with the open method of operation.

Purpose of the study. Determine the frequency of MiNeN among pancreatic carcinomas and analyze the survival rate of patients depending on the percentage of cells with neuroendocrine differentiation in the tumor.

Materials and methods. The current study included 31 patients with a pancreatic tumor who received surgical treatment at the Rostov Cancer Research Institute. An immunohistochemical study was conducted on biomarkers of chromogranin A, synaptophysin, and ki-67 for these patients. Based on the data obtained, 4 groups for neuroendocrine differentiation were identified.

Results. The direct effect of neuroendocrine differentiation on the survival of patients with histologically confirmed pancreatic ductal adenocarcinoma has been proven. Among the sample of 31 patients, neuroendocrine differentiation was revealed in 24 cases (77%), of which 3 cases of MiNeN (10.3%) were detected. It is also proven relationship between neuroendocrine and patient survival, where an increase percent of positive cells in tumors (chromogranin A or synaptophysin) means a better prognosis. Chromogranin A is a more significant predictor of survival compared to synaptophysin. The largest difference in survival was between negative expression of chromogranin A and the presence of more than 1% positive cells in the tumor.

Conclusion. We supposed that it is necessary to use neuroendocrine markers (chromogranin A and synaptophysin) in the diagnosis of ductal adenocarcinomas, even without histological signs of neuroendocrine differentiation. This will allow for a larger amount of data to determine their significance as prognostic markers.

The aim of investigation: to assess the possibilities of diagnostic and therapeutic BAE in a multidisciplinary hospital.

Materials and Methods: The analysis of the findings was carried out in 32 patients who underwent 40 diagnostic and 17 therapeutic procedures. Small bowel ulcers were detected in 6 patients, angioectasias in 5. One patient with subcompensated jejunal stricture in the suprastenotic section was found to have a bezoar foreign body. In 17 patients, tumors of a different nature were identified: carcinoids in 4, gastrointestinal-stromal tumors (GIST) in 6 patients, adenocarcinomas in 7 patients. One patient was diagnosed with varicose veins of the jejunum, complicated by bleeding. In 9 patients, polyps of the jejunum and ileum were identified. Reoperations were planned in 6 patients.

Results: When conducting therapeutic balloon-assisted enteroscopy, the following types of endoscopic treatment were used: endoscopic clipping (angiectasia-4 and ulcers-2), argon plasma coagulation was used in 1 case, endoscopic polypectomy was performed in 9 patients, destruction of the bezoar with a diathermic loop and balloon dilatation strictures in one case. Patients who had a pathology that was not subject to endoscopic treatment were operated on.

Conclusion: The availability of modern equipment significantly expands the capabilities of clinicians in the differential diagnosis of pathological conditions of the small intestine and allows for minimally invasive treatment, shortening the rehabilitation period due to the reduction of surgical trauma.

The steady increase in the number of patients with chronic diff use liver diseases, including non-alcoholic fatty liver disease, leads to the need to introduce non-invasive methods of diagnosis and monitoring changes in the structure of the organ into clinical practice.

Objective. To evaluate the possibility of using shear wave steatometry and elastography in the diagnosis of fi brosis stage and degree of steatosis in patients with non-alcoholic fatty liver disease.

Materials and methods of research. The study involved 52 patients of the I. I. Mechnikov NWSMU clinic with NAFLD, 28 of them men and 24 women, the average age was 51-+11.2 g, the average BMI-30,7-+5,4 kg / m². The control group consisted of 20 healthy volunteers. All patients underwent complex ultrasound on the Angiodin-Sono/P-Ultra device (Bioss, Russia) with a 1–6 MHz convexic sensor (B-mode, Doppler modes—vascular mapping and spectral pulse, shear wave elastometry, elastography (active and natural compression—Active / Natural Strain)).

The purpose of the study: The main purpose of the study is creation of a system for digital processing of endoscopic images in white light and narrow band imaging for the early diagnosis of early forms of stomach cancer.

Materials and methods: The object of the study is endoscopic images (6320 cases) with PENTAX EG-2790K and OLYMPUS H180 devices. The subjects of the research are mathematical models of gastric epithelial neoplasias, classifi cation of these tissues, methods of digital image processing and contour analysis, methods of mathematical modeling.

Results: The work is divided into two stages to obtain quantitative estimates of the studied characteristics: 1. To make a diagnostic map — the image is segmented, then the boundaries between the pathologically altered tissues and the normal mucous membrane are drawn. 2. The calculation of the characteristics of the contour associated with diagnostic signs is made. As a measure of the symmetry of the figure, the symmetry coefficient k was used, defined as the ratio of the number of samples of the normalized autocorrelation function that exceeded the specified threshold in level to the total number of samples. The study revealed that the contours of malignant neoplasms have a symmetry coefficient k < 0,05, and the contours of benign neoplasms k > 0,2. This suggests the possibility of automated differentiation of neoplasms based on the analysis of their shape.

The conclusion: An objective assessment of endoscopic signs of early gastric cancer is necessary to standardize and systematize the diagnostic approach. The unified digital processing of endoscopic images will allow the endoscopist to increase the frequency of detecting early forms of gastric cancer, which will affect to reduce mortality.

Introduction. Assessment of proactive local anesthesia’s influence on how early postoperative period after hemorrhoidectomy undergoes.

Materials and methods. The object of the study were 50 patients operated on for chronic combined hemorrhoids (stage 3). In the period from November 2018 to June 2019, they all had open hemorrhoidectomy made according to the standard method. All operations were performed under spinal anesthesia. Patients were divided into the main group (n = 26), operated on under proactive local anesthesia (PLA) with 0,75% ropivacaine solution and a comparison group (n = 24) that had not had PLA. The introduction was carried out immediately before hemorrhoidectomy after the spinal block was performed at 5 points. Pain was assessed with the help of questionnaires based on a visual analogue scale (VAS), 2, 4, 8, 24, 48 hours after surgery.

Results. The level of postoperative pain in the main group was lower than in the comparison group (p<0.05) and did not exceed 1,78 points by VAS. In the comparison group, the level of postoperative pain after 8 and 24 hours on average exceeded 5 points by VAS. Patients of the main group did not need postoperative anesthesia in 68,5% (n = 17) cases, while in the comparison group 57% patients (n = 17), needed from 3 to 5 injections of NSAID to provide adequate pain relief.

Conclusion. The use of a 0,75% ropivacaine solution for PLA reduces pain after hemorrhoidectomy, which does not lead to the need for additional analgesia in the early postoperative period and improves the patient’s quality of life.

The aim—to characterize violations of the motor function of the biliary system in PSC in the clinic and experiment; to reveal the morphological correspondence of the studied pathology model.

Materials and methods. Under observation were 20 patients with PSC in whom the motor function of the biliary system in the clinic was studied electromyographically. The frequency and amplitude of slow waves and spikes, the power of phase and tonic contractions were recorded on the EMG curve. PLC was simulated in 28 rats when 0.1 ml of picrylsulfonic acid was retrogradely injected into the common bile duct.

Results. Electromyography of the common bile duct revealed an increase in the tone of circular muscles, a proportional increase in the power of phase and tonic contractions of the gallbladder with a decrease in the amplitude characteristics of spike activity. When simulating PSC, inhibition of EMG of the common bile duct and the detection of fibrosis of the type “bulbous husk” were noted.

Conclusions. A decrease in the propulsive activity of the common bile duct in patients was found. The PSC model corresponds to the characteristics of this disease in the clinic.

Stomach cancer is the third most deadly cancer in the world. Undoubtedly, the operative method is a priority in the treatment of stomach cancer. The history of development, formation and improvement of gastric cancer surgery dates back almost 140 years. During this time, the priority of numerous studies was to develop the most reliable and physiological method of reconstruction after gastrectomy. To date, the literature describes more than 70 different options for reconstruction after gastrectomy, many of which are used in practice. Globally, there are two main types of reconstructive stages after gastrectomy: without preservation and with preservation of the duodenal passage. The advantages and disadvantages of these stages after gastrectomy continue to be the subject of heated discussions among surgeons, as studies of the immediate and long-term results of various types of these operations are extremely contradictory. We did a historical literature review to identify the most optimal reconstruction method in patients with gastric cancer after gastrectomy.

Portal hypertension is a symptom complex that develops as a result of impaired blood flow in the portal system, the leading symptom of which is an increase in pressure in the portal vein over 12 mm Hg. Art. According to statistics in developed countries, 90% of cases of portal hypertension are associated with liver cirrhosis. The most formidable and fatal complication of portal hypertension is bleeding from varicose veins of the esophagus and stomach. The risk of bleeding is 4–5% per year, and in the presence of varicose veins of the esophagus from 15 to 30% or more, the mortality rate is 50%, with a recurrence rate of 50 to 90%. And the fact that today there is no unified approach to solving this problem in the world prompted us to take a short literary review on this topic.

The pancreas is an organ that plays a key role in the digestive process, preparing food ingredients such as proteins, fats and carbohydrates for adequate absorption in the small intestine. Today, a wide range of pathological conditions is known in which the tissue of the pancreas is affected and its functions are lost. The literature review examined various diseases that phenotypically manifest as pancreatitis, as well as various diagnostic and therapeutic strategies.

The review is devoted to the problem of treatment of non-alcoholic fatty liver disease, which is the most common pathology of the hepato-biliary system worldwide and is characterized by an increasing frequency, including of more severe forms. A wide range of pathogenetic relationships of non-alcoholic fatty liver disease with diseases of other organ systems, primarily with diseases of the cardiovascular system, type 2 diabetes mellitus, chronic kidney disease and diseases of the biliary tract, is presented. The main mechanisms of comorbidity are insulin resistance, oxidative stress, inflammation, disorders of carbohydrate and fat metabolism. An approach to the therapy of this disease based on the concept of comorbidity has been substantiated. As a rational therapeutic choice, a molecule of glycyrrhizic acid is presented, which has pleiotropic effects, including anti-inflammatory, antioxidant, antifibrotic and immunomodulatory effects. The evidence base for glycyrrhizic acid is formed by a large array of clinical trials, including randomized placebo-controlled trials conducted both in Russia and abroad, in infectious and non-infectious liver diseases, including non-alcoholic fatty liver disease. Attention is focused on non-alcoholic fatty liver disease with intrahepatic cholestasis associated with a more severe course and high rates of disease progression. A theoretical justification for the use of a combination of glycyrrhizic acid and ursodeoxycholic acid in such patients is presented. The reason for this is the potential synergy of the two molecules, based on the induction of CYP3A4, and associated with the effect on inflammation, as a factor in the development of intrahepatic cholestasis and cholestasis itself.

The purpose of the study: to assess clinical efficacy, dynamics of liver steatosis, effect on insulin resistance and hypolipidemic, ammonia level, systemic inflammation of the Heptrong in patients with non-alcoholic fatty liver disease (NAFLD) and dyslipidemia with obesity.

Materials and methods. The study included 40 patients (23 men), age Me 48 (41–53) years, BMI Me 30.5 (28–34) kg / sqm. Inclusion criterion: presence of fatty hepatosis in ultrasound and the ALT level is more than 1.5 norms. Asthenia (AVS) was detected in 78% of patients, abdominal pain in 65% (hepatomegaly, chronic cholecystitis), flatulence in 26%, dyspepsia in 32%. In 36% of patients there was arterial hypertension, in 54% of cases — insulin resistance, in 72% of cases — dyslipidemia with hypertriglyceridemia. Before therapy, patients had an increase in the level of ALT up to 1.9 norms, AST up to 2.1 norms, GGTP up to 1.8 norms, total bilirubin — 1.4 norms, glycated hemoglobin — 1.2 norms, HOMA index up to 1,3 norms, total cholesterol up to 1.3 norms, triglycerides up to 1.4 norms, CRP up to 1.2 norms and ferritin up to 1.3 norms, combined with an increase in CRP and leukocytes up to 1.2 norms. According to the results of liver FIBROSCAN, hepatic steatosis was detected in all patients, Me CAP 295 (254–343), liver fibrosis was detected in 32% of cases (Me 6.4 (5.4–7.6) kPa). The level of ammonia in the peripheral blood on an empty stomach was Me 72 (42–91) mmol / l (with a norm of up to 54 mmol / l). Heptrong was prescribed in the form of 3 courses of 10 intramuscular injections according to the scheme 3.0 ml-3 ml-6.0 ml-6.0 ml-9.0 ml-9.0 ml-6.0 ml-6.0 ml-3.0 ml-3.0 ml for 3 months.

Resaults. After 1 month of Heptrong therapy according to the scheme, there was a significant decrease (p≤0.05 according to the Wilcoxon criterion) in the frequency of AVS, pain and dyspeptic syndrome, the level of bilirubin, ALT, CRP, ferritin, ammonia, GGTP. After 3 courses of therapy, the examined patients showed further regression of clinical syndromes. During examination and communication, a positive trend was noted on the scales of quality of life and level of anxiety. Revealed a decrease in Me ALT by 31% (p <0.05); decrease in AST by 28% (p <0.05); GGTP — by 33% (p <0.05); glycated HB — by 15% (p <0.05); CRP — by 10% (p <0.03) ; ferritin — by 11% (p <0.05), ammonia — by24% (p <0.05); HOMA — index by 15% (p <0.04); total cholesterol — by 12% (p <0.05); triglycerides — by 20% (p <0.05); LDL — by 19% (p <0.05); HDL + 18% (p <0.05); Liver steatosis (dВ / m²) –26% (p <0.05); Liver fibrosis — reduction of 1 stage (Metavir) in 28% of patients. A positive response to therapy correlated (r> 0.3) with the patient’s age, male gender, BMI, Homa index, LDL, CRP, ammonia, ferritin.

Conclusions. During the course of treatment with Heptrong, patients with NAFLD experience regression of clinical symptoms, stigma of systemic and local inflammation, correction of metabolic disorders, and improvement in the quality of life.

This article presents the clinical case of using combination of minimally invasive approaches of debridement in patient with infected necrotizing pancreatitis. The decision of using minimally invasive approaches: endoscopic transluminal pancreatic necrosectomy combined with percutaneous catheter drainage under US-navigation and video-assisted retroperitoneal debridement was made, due to the giant necrotic cavity, containing huge amount of necrotized tissues (diagnosed by instrumental methods—CT, US).

Discussion: Acute necrotizing pancreatitis is still the important surgical problem, because of the great number of different complications and high level of mortality, despite achievements in the treatment of this group of patients. Many articles, focused on the use of modern minimally invasive approaches in case of infected necrotizing pancreatitis, have been published. Moreover, the combination of minimally invasive approaches is using in managing of some patients for better debridement (including minimally invasive methods of debridement).

Conclusion: The combination of minimally invasive ways of debridement in patients with necrotizing pancreatitis is an effective surgical tactic, which leads to better results in treatment.

A 60-year-old man admitted to the clinical center due to weakness, episodes of jaundice. The laboratory date revealed elevated levels of total bilirubin—112.5 μmol/l (range 8,5–20,5 μmol/l) and direct bilirubin—60.8 μmol/l (range 4,3–4,6 μmol/l), elevated hepatic enzymes (aspartate aminotransferase [AST]: 95 U/l (range ≤ 40 U/L), alanine aminotransferase [ALT]: 301 U/l (range ≤ 30 U/L). When performing esophagogastroduodenoscopy, a polyp of the large duodenal papilla with a spread to the terminal parts of the bile and pancreatic ducts was revealed, and a biopsy was taken. Histological examination detected tubulovillous adenoma with epithelial dysplasia II–III stage. DS: “Tubulovillous adenoma of the major duodenal papilla with epithelial dysplasia II–III”. Complications: “Multiple choledocholithiasis. Mechanical jaundice. Liver failure.” Considering the inability to carry out endoscopic treatment, recurrent nature of the jaundice it was decided to perform surgery: laparoscopic duodenotomy, papillectomy, choledocholithotomy, performing of choledochoduodenal anastomosis, duodenoplasty and abdominal drainage. The postoperative period was taking its normal course. Duration of staying in the intensive care unit—4 days. Enteral fluid intake started on the 2-nd postoperative day. Enteral feeding was restored in a 3 days. Polyps of the large duodenal papilla are relatively rare form of tumors of the gastrointestinal tract, which may not manifest clinically, or, as the above case, lead to severe pathological conditions. Currently, there is no single approach to the treatment of this group of diseases. Some authors propose a pancreatoduodenal resection, but the risks of this operation associated with high postoperative morbidity and mortality are not always justified. The case is unique because the described procedure is less invasive and affects the minimum number of organs. Laparoscopic approach has significant advantages in the treatment of this infrequent pathology.

Background and Objectives: Increasing application of EUSguided biliary drainage, however, does not determine the capabilities of complete EUSinvestigation of the common bile duct in patients with surgically altered upper gastrointestinal anatomy. The purpose of this study is to evaluate the specifi city and eff ectiveness of EUS for choledocholithiasis in a patient with Billroth II altered anatomy.

Patient and Methods: A 61-year-old female patient underwent a Billroth II gastric resection about 25 years ago. Choledocholithiasis was diagnosed a year ago. At the present examination, the results of ultrasound and MRCP were doubtful. Gastroscopy showed the ability to intubate the afferent limb with accessible papilla. EUS was performed to decide on further patient management.

Results: The common bile duct EUS-visualization was performed both from the gastric stump and from the afferent limb. The differences of intubating the afferent limb in comparison with the EGD, as well as the differences of the ultrasound picture in comparison with the traditional EUS of CBD were determined. Two CBD stones were detected by scanning from the afferent limb. ERCP was done in the same sedation session with balloon papilla dilatation and both stones lithoextraction. Laparoscopic cholecystectomy was performed on the second day without complications. The patient was discharged from the hospital on the fifth day after surgery. Within 10 months she feels well, no complaints.

Conclusions: EUS can be diagnostic method of choice for choledocholithiasis in patients with Billroth II altered anatomy if intubation of the afferent limb was confirmed endoscopically.

Paper is devoted to the III international Eurasian endoscopy forum “UralEndo”, which took place in Yeakaterinburg 4–5 September 2020. In the brief review the first experience of the major international online endoscopy conference in Ural region of Russia is summarizing with evaluation of the main forum ideas and putting on the nearest developing tasks oriented on the modern scientifi c achievements and progressive international experience of their implementation into wide endoscopy practice.