Aim: to determine the frequency of erosive and ulcerative defects and ulcerative bleeding of the gastroduodenal zone in patients with COVID-19 infection.
Materials and methods. Fibroesophagogastroduodenoscopy was performed in patients in the hospital for the COVID-19 infection treatment when they had heartburn, dyspepsia, or signs of gastrointestinal bleeding among patients. In total, endoscopy was performed in 387 patients (116 men and 271 women, mean age 65.4 years). Erosive esophagitis was assessed according to the Los Angeles classification (1994), candidiasis esophagitis according to the Kodsi classification (1976), esophageal varices according to K. J. Paquet (1983), classification of ulcerative bleeding according to J. A. Forrest (1974).
Results. Erosions in the esophagus was found in 25.3% of the examined patients, gastric and duodenal erosions—in 44.4% of persons, gastric and duodenal ulcers — in 10.1% of patients. Gastroduodenal bleeding was determined in 5.7% of the examined patients and was associated with ulcerative defects in 81.8% of cases. Male gender was a strong risk factor for erosions, ulcers, and bleeding from the upper gastrointestinal tract.
Conclusion. In patients with COVID-19, complications from the gastrointestinal tract, manifested by ulcerative defects and bleeding from the gastroduodenal zone, are a significant problem. It seems rational to propose to treat patients with COVID-19 infection receiving massive anti-inflammatory, anthrombocytic, anticoagulant therapy in the same way as is customary in the management of cardiological and rheumatological patients for the prevention of NSAID-gastropathy.

Stomach cancer has an important place in medicine. Unfortunately, diagnosis of gastric cancer is being established in majority of cases at the IV stage. So, yt is necessary to detect tumors at the earliest stages of carcinogenesis and to evaluate and treat precancerous diseases, such as gastric atrophy and intestinal metaplasia.
Aims: To estimate the value of Narrow-band imaging Dual focus (NBI Dual Focus) endoscopy capabilities in differential diagnosis of intestinal metaplasia types. We evaluated the data of Russian and foreign articles on this topic from 2011 to 2021. In our study 46 patients with suspected intestinal metaplasia admitted to Nizhny Novgorod Oncology Dispensary. We have performed multimodal endoscopy, including White light endoscopy (WLI), narrow-band imaging (NBI, WLI, BLI — 28) and Dual focus endoscopy (18). Sydney system based multifocal biopsy and targeted biopsy of IM foci were performed in all cases.
Results: Verification of intestinal metaplasia, visualized with WLI, was confirmed in only 59% cases. However, intestinal metaplasia, observed with NBI, was confirmed by pathology in 100% cases. NBI Dual Focus endoscopy made possible to differentiate complete and incomplete intestinal metaplasia also in all patients.
Conclusions: Intestinal metaplasia can be successfully diagnosed with NBI endoscopy. Differential diagnosis of types of intestinal metaplasia and other variants of gastric mucosa metaplasia is possible using narrow-spectrum endoscopy with dual focus (NBI Dual Focus).

The article presents an analysis of the results of video capsule endoscopy (VCE) of the esophagus, stomach and elements of the esophageal-gastric junction (EGJ) in 23 patients without pathology of the upper gastrointestinal tract (conditionally healthy). It was concluded that VCE can be used as a method for studying the elements of the EGJ: the opening of the esophagealgastric junction in closed and open states, the shape of the Z-line and the figures that it forms, as well as the distance at which the Z-line is located in relation to the cardia is normal. VCE is characterized by a study in physiological conditions without the influence of mechanical factors that arise when performing traditional esophagogastroscopy.

Introduction. Studies of the gastric mucosa using biomarkers of its functional state in children are isolated, and there is also no normative base for their assessment.
The aim of the work was to establish the reference values of the levels of gastrin-17, pepsinogens I and II in the blood serum of children and the nature of their changes in chronic Hp-associated gastritis.
Material and methods. 112 children aged 7–15 years with chronic gastritis associated with Hp were examined. The examination program included esophagogastroduodenoscopy, morphological examination of gastrobioptates and determination of serum concentrations of gastrin-17, pepsinogens I and II, class G antibodies to Hp.
Results. A regulatory framework has been developed to assess serum concentrations of gastrin and pepsinogens in childhood. It was found that as infl ammation progresses in chronic Hp-associated gastritis in children, an increase in the level of biomarkers, as well as the titer of class G antibodies to Hp, is observed. Changes in the content of biomarkers in the blood serum of children are uninformative in relation to the diagnosis of atrophic gastritis.
Conclusion. These studies of serum levels of gastrin-17, I and II and class G antibodies to Hp pepsinogens can be used as an additional non-morphological criterions for the severity of the infl ammatory process in the gastric mucosa during dynamic monitoring of children with chronic gastritis.

Gallstone disease continues to occupy a leading position in terms of the number of surgical interventions in modern emergency surgery.
The purpose of our study is to determine the risks of developing post-manipulation pancreatitis depending on the method of sanitation of the choledochus, to determine the dynamics of regression of hyperamylasemia and hyperbilirubinemia in patients after endoscopic papillosphincterotomy (EPST), to assess long-term results—the frequency of repeated hospitalizations and the need to perform surgical interventions for restenosis of the papilla.
Materials and methods: a prospective analysis of 60 clinical cases of patients after EPST was performed. Patients were divided into 2 groups depending on the method of sanation of the common choledochus. The frequency of development of an increase in the level of blood amylase and bilirubin and the timing of regression of these indicators were assessed. An analysis was also made of repeated cases of hospitalizations and the need for interventions on the papilla.
Results: the development of hyperamylasemia in the group of revision of the choledochus occurred in 23% of cases, in the group without mechanical sanitation — in 13%. Hyperbilirubinemia in the immediate postoperative period developed in 27 and 23% of cases, respectively. The terms of regression of elevated biochemical parameters were higher in the group of patients with a mechanical method of sanation of the common choledochus.
Conclusion: mechanical methods of sanation of the common choledochus can increase the incidence of post-manipulation complications after EPST and increase the recovery time for normal values of biochemical parameters. To assess the longterm results of the development of papillary restonosis after EPST, it is necessary to form larger groups of patients with the possibility of conducting a multicenter study.

A comparative assessment of the possibility of studying the endoscopic anatomy of the esophageal-gastric junction (EGJ) among apparently healthy men and women aged 18 to 80 years using traditional esophagogastroduodenoscopy (EGDS) and video capsule endoscopy (VCE) was carried out.
It is concluded that VCE, like traditional EGDS, allows them to be studied, but there is a difference in the shapes and sizes of the elements of its components, which is associated with the presence of physiological conditions during VCE, in contrast to traditional EGDS.
Each of these methods has its own criteria of the norm, which should be guided by when conducting scientific research, diagnostic, therapeutic and surgical interventions in the area of the esophageal-gastric junction.

Introduction. Irritable bowel syndrome (IBS) affects a significant portion of the population worldwide. The disease is characterized by a multifactorial pathogenesis and a variable clinical picture, in the center of which is abdominal pain and violations of the act of defecation. Our work shows the relationship between the functional polymorphism of the serotonin reuptake transporter (5-HTTLPR of the SLC6A4 gene) and the features of myoelectric activity (MEA) of the small intestine in various clinical variants of IBS.
Purpose — to study clinical, functional and genetic features in patients with IBS and on their basis to determine significant risk factors for the formation of various IBS variants.
Materials and methods. 148 patients were examined: 79 patients with IBS (group 1), including 45 patients with IBS with a predominance of diarrhea (group 1a) and 34 patients with IBS with a predominance of diseases (group 1b), 10 healthy volunteers (group 2), 59 patients of therapeutic profile without IBS (group 3). The diagnosis of “IBS” was established according to the Rome criteria III revision. All of them thoroughly studied peripheral electrogastroenterography (PEGEG) and groups of patients 1 and 3 — genetic analysis of the 5-HTTLPR polymorphism of the SLC6A4 gene.
Results. In the diarrheal variant of IBS, the 5-HTTLPR promoter more often contains the S allele associated with a decrease in the function of the serotonin reuptake transporter. The risk factors for the formation of clinical variants of IBS include: gender, polymorphic variants of the 5-HTTLPR gene SLC6A4 and the values of the postprandial coefficient of myoelectric activity (MEA) at the frequencies of “ileum” and “jejunum”.
Conclusions. The revealed relationships between the motor-evacuation function (MEF) of the gastrointestinal tract and polymorphism of the serotonin transporter gene demonstrate the pathophysiological significance of these associations in the development of IBS and its clinical variability. Features of the functioning and genetic features of the serotonergic system deserve further study, which is promising for improving the diagnostic and therapeutic approach to patients with IBS.

Risks of the working environment associated with the psychosomatic status and professional burnout syndrome of medical personnel affect the quality and safety of medical activities. This is especially important in endoscopy, where specialists are required high concentration, excellent manual skills, well-coordinated actions, patience and endurance. Timely identification and elimination of professional burnout risks in endoscopy is helpful for improvement the safety and quality of the endoscopic interventions. The evaluation and analysis of these risks is part of the modern risk management system. The article presents the results of the professional burnout risks assessment in endoscopy. The study was carried out according to an anonymous survey of 109 endoscopists and endoscopic nurses in Sverdlovskaya and Yaroslavskaya regions.

138 patients who were diagnosed with gastric and duodenal ulcers during EGDS were treated. The inclusion of exogenous nitric oxide in the anti-ulcer treatment of patients contributed to the eradication of Hp, restoration of the membrane component of damaged cells, stabilization of local immune reactions and humoral immunity. NO-therapy accelerated the epithelialization of ulcers by 2 times compared to patients who did not receive nitric oxide in complex therapy.

Background: the method of endoscopic submucosal dissection (ESD) allows to remove large neoplasms of the GI tract enblock, which significantly reduces the risk of local tumor recurrence. However, ESD method is technically complicated with high risk of surgical complications.
Aim: to modify ESD traction technique and evaluate its efficiency.
Materials and methods: experimental comparative study on biological preparations (pig stomachs). 144 ESD with three different methods were performed: the 1^st group—standard ESD method (n-48); the 2^nd—ESD with the method of traction with the clip and thread (n-48); the 3^rd—ESD with a modified method of tumor traction (n-48).
Results: the shortest time to submucosal dissection was 4.89 min [2–12] in the 3^rd group, and 13,27 [4–31] min and 9,37 [4–26] min in the 1^st and 2^nd, respectively (p = 0,05). Total operative time in the 3^rd was 21,10 [12–31] min, in the 1^st 23.85 [12–48] min, and in the 2^nd—25.56 [13–49] min, p = 0.002. The max dissection speed was 0.48 [0.20–1.27] (min/cm²) in the 3^rd group, 0.94 [0.47–2.06] (min/cm²) and 1.48 [0.56–4.10] (min/cm²) in the 2^nd and 3^rd, respectively, p=0.003. HM0 was 89.6% [43/48] in group 1, 93.7% [45/48] in the 2^nd, and 100% [48/48] in the 3^rd, p>0.05. Muscle layer damage during submucosal dissection was 25% [12/48] in the 1^st, 6.25% [3/48] in the 2^nd and 12.5% [6/48] in 3^rd, p=0.389.
Conclusion: the modified traction method during endoscopic submucosal dissection allows to visualize submucosa layer better, to increase dissection speed thus reducing total time of the operation and time of submucosal dissection.

Objective: modeling various types of surgical procedure in an experiment in rats, assessing the effect of surgery on the motility of the gastrointestinal tract (GIT).
Materials and methods: the study was carried out on 30 female Wistar rats weighing 200–250 grams, comparable in age, divided into 3 groups (10 animals each) in random order. group 1 — rats underwented to laparotomy (LT), group 2 — laparotomy, creation of a loop colostomy (LT + C), group 3 — laparotomy, a colonic single-row anastomosis (LT + A). Gastrointestinal motility was assessed using the gastrointestinal transit index (GTI), calculated by the formula: (length of the stained area of the intestine / total length of the intestine) x100, as well as by the results of a morphological study.
Results: surgery has a depressing effect on the motility of the gastrointestinal tract, while the maximum decrease in IHT was noted in the Colostomy group: 1.08±1.4% versus 2.3±3.3% in the Laparotomy group and versus 3.8±1.8% in the Anastomosis group. Comparison of the groups “Colostomy” and “Anastomosis” showed a significant difference in this feature — p=0.002.
Conclusion: modeling of various surgical procedure in rats made it possible to prove the relationship between the formation of a stoma and the inhibition of gastrointestinal motility, further study of this pattern will allow us to develop ways to prevent the development of postoperative ileus.

The study is based on the treatment of 79 patients with adenocarcinoma of large duodenal papilla and extrahepatic bile ducts. 29 patients received palliative bile drainage operations with PDT. 50 patients in the group of chronological control only palliative bile drainage operations had been performed. Patients in research group received from 1 to 3 PDT courses in a year. In total 29 patients received 52 PDT courses. Outcomes were assessed by determining the median survival.
The treatment was well-tolerated by the patients. The median survival time was 18 months (11–60 months). In patients who had only one PDT session during the year median survival was 12,5 months; in patients who had two or more PDT sessions median survival was 29 months (15–60 months).
Results of PDT treatment for cancer of this localization are comparable with the results of radical surgeries and overcome palliative surgeries. Decrease of tumor growth rate and longer survival period in patients after PDT are determined by vascular mechanisms produced by PDT (vascular thrombosis and impaired tumor blood supply), these factors provide long-term process stabilization. Repeated PDT courses signifi cantly improve treatment results.

The article is devoted to the evaluation of methods for the prevention of post-manipulation pancreatitis based on the analysis of hyperamylasemia in patients with acute biliary pancreatitis, who underwent transpapillary interventions.
Aim of the study. To assess the impact of a new method of preventing post-manipulation complications on the rate of regression of hyperamylasemia in acute biliary pancreatitis.
Materials and methods. In 2015–2021, 70 patients with proven acute biliary pancreatitis who underwent transpapillary interventions were included. Men—16 (23%), women 54 (77%). In 56 patients (Group 1), complications were prevented after the intervention by submucosal infiltration of a 0.5% lidocaine/novocaine solution, 10 ml. 14 patients (Group 2) used the new technique in the prevention of complications (priority certificate No. 2021137430 dated 12/16/2021). The level of amylasemia was monitored 6–8 hours after papillotomy, then daily until normalization. In 10 patients of the 2nd group, stenting with a plastic stent was also used.
Results. The time for regression of hyperamylasemia to 100 units/l between groups 1 and 2 was 6.8±1.9 days versus 4.5±2.3 and differed significantly. Without a stent, the level of amylasemia in the 2nd group returned to normal within 2 days, with the use of a stent—within 4 days, without statistical differences. Evaluation of the rate of regression of reactive hyperamylasemia in patients with normal amylase levels at the time of endoscopic intervention revealed a reduction in the duration of the period of hyperamylasemia when using double PBB. Comparison of the rate of regression of hyperamylasemia in acute biliary pancreatitis with conventional PBB with changes in reactive hyperamylasemia after EPT without PBB showed a similar picture.
Conclusions.
1. A new technique for the prevention of post-manipulation complications is promising and requires additional evaluation.
2. PBB after the intervention does not significantly affect the rate of regression of hyperamylasemia.
3. Stenting of the pancreatic duct in acute biliary pancreatitis tends to prolong the duration of hyperamylasemia.

The aim: to evaluate the efficacy and safety of endoscopic removal of laterally spreading tumors—LST of the colon by pEMR.
Materials and methods: analysis of data obtained during endoscopic treatment of colon LST and dynamic observation of patients.
Results: after analyzing and systematizing the data obtained, the advantages and disadvantages of pEMR for colon LST removal are clarified.
Conclusion: if the correct technique of performing pEMR is observed, visual assessment of the completeness of resection and subsequent careful dynamic observation, removal of LST of the colon by pEMR is effective and safe, and can be used in conditions of unavailability of the ESD technique.

The results for “string-to-ring” ESD and conventional ESD were compared in present study. The “string-to-ring” method was developed to create traction using a thread, fixed to the edge of the tumor, that is moved through a ring, located on the clip on the opposite wall. The study included 41 ESDs of the lesions larger than 3 cm in the rectum, that were performed from October 2016 to June 2021. Patients were divided into two groups (“string-to-ring” ESD, n = 19; conventional ESD, n = 22). Time of the procedure and the frequency of complications were evaluated.
Analyzing the obtained data, the “string-to-ring” method allowed to shorten the operation time (from 85,8 ± 17,5 to 63,6 ± 15,3 min), reduce the rate of intraoperative bleeding and perforations from 19% to 0%.
At the conclusion, ESD with “string-to-ring” traction—a promising technique with potential for clinical application. The advantage of this method provide better visualizing the submucosal layer due to the direction of gravity. This method facilitates ESD, reduces procedure time and the number of intraoperative complications—bleeding and perforation.

Anal cancer is a rare malignancy of the distal gastrointestinal tract, often associated with human papillomavirus, the most common sexually transmitted infection worldwide. Currently available screening methods for anal intraepithelial neoplasia, a precursor for anal cancer, combine anal Papanicolaou cytology and high resolution anoscopy with biopsy of suspicious lesions. It is well known that the anal canal is an area examined by proctologists, however, with endoscopic examination, cancer of the anal canal can also be detected, including in the early stages of the tumor process. When conducting an endoscopic examination of the lower gastrointestinal tract, the most common cause of incomplete examination of the colon during colonoscopy is poor preparation, less often—the anatomical features of the colon. An endoscopist, who examined the colon often skip the changes related to the lower ampullar part of the rectum and the anal canal, because of quickly removing the endoscope and not using the technique of examining this area in retrofl exed mode. This review describes the epidemiology of anal intraepithelial neoplasia and anal cancer and carcinogenesis in the population of the Russian Federation, presents an algorithm for examining patients at risk, diagnostic and therapeutic endoscopic techniques that allow timely diagnosis of pathological conditions of the lower ampulla of the rectum and anal canal, also presents modern possibilities of endoscopic treatment of this pathology.

Endoscopic submucosal dissection (ESD) is currently an advanced method of treating early cancer of the upper and lower gastrointestinal tract. The ESD allows to remove tumors of any size in an en-bloc, unlike endoscopic mucosal resection (EMR), when we can remove lesions completely only less than 20 mm in size. Despite this advantage, ESD is accompanied by more perforations and bleeding than EMR. Difficult anatomical localization, an unexpressed muscle layer of the organ wall, fibrosis of the submucosal layer and insufficient experience of the operator are the main causes of incomplete resections of the tumor, the development of complications and relapses.
The described methods of tumor traction during submucosal dissection allow increasing the value of en-bloc resection and achieving histologically complete resection. We have presented a wide variety of different methods of tumor traction when performing ESD. We have noted both advantages and disadvantages of traction techniques in endoscopic intraluminal surgery.

There are modern presentation about diseases of the duodenum: malabsorption syndrome, celiac disease, Uippls disease, chronic duodenal obstruction, lymphoma. Diagnosis and differential diagnosis of these diseases are the complex problem and are established on the basis of endoscopic imaging and morphological investigations of biopsy material obtained during esophagogastroduodenoscopy.

A 71-year-old patient with cicatricial stricture of the esophagus at the place of residence underwent bougienage, balloon dilatation and electric incision of the scar with a short-term effect.
In March 2020, the patient applied to the Petrovsky National Research Center of Surgery with dysphagia grade 3 according to Bown. In the endoscopic department, multiple critical cicatricial strictures of presumably burn etiology were diagnosed, and therefore a long course of endoscopic bougienage was carried out, starting with Soehendra bougie with a diameter of 6 Fr to Savary bougie 45 Fr with an interval from 1–2 days to 2 weeks. Due to the tendency to rapid restenosis during this time, treatment was supplemented with 4 courses of intramural injections of dexamethasone solution. Despite the lack of a stable effect, the patient refused surgical treatment. Due to persistent restenosis, an innovative treatment was carried out—intramural injection of autologous lipoaspirate (nanofat) into the narrowed zone in order to reduce the density and rigidity of the scar tissue. At the final stage, in order to stabilize the lumen and prevent further restenosis, a course of intramural injections of triamcinolone was performed. This made it possible to successfully complete a two-year course of planned combined endoscopic treatment.

Problems of obesity and its accompanying metabolic disorders remain relevant throughout the world and are due to an increased risk of disability and early mortality in patients with this pathology. Currently, bariatric surgery is recognized as the most effective treatment for morbid obesity. Of exceptional importance are not only the technical features of operation, but also a full preoperative examination. The occurrence of gastric cancer after bariatric surgery is a rare but occurring phenomenon, often associated with insufficient quality of preoperative endoscopic examination. We presented a clinical case of endoscopic diagnosis and removal of early cardioesophageal cancer in a patient with morbid obesity, three months after mini-gastric bypass surgery, as well as examine bypassed stomach with single- balloon enteroscope.

A patient with achalasia cardia after surgery for spontaneous rupture of the lower third of the esophagus developed failure of surgical suturing and a chronic esophago-pleural fistula. A control computed tomography of the chest with contrasting of the pleural cavity through the drainage revealed a filiform bronchial fistula. After the completion of endoscopic vacuum aspiration therapy, which consisted of four sessions, positive dynamics was noted in the form of the absence of air and fluid inflow through the drainage, as well as a significant decrease in the fistula orifice according to the endoscopic examination. A positive result was confirmed by X-ray, fistulography and computed tomography with contrasting—no contrast agent was received outside the esophagus and into the left bronchus. 5 months after discharge from the hospital, the patient underwent a combined course of endoscopic balloon dilatation with a good effect due to stage 3 achalasia cardia. According to computed tomography, endoscopic and X-ray examinations, there is no recurrence of the fistula.

Introduction. Duplication cysts (DC) of the gastrointestinal tract are a rare congenital anomaly. According to its structure, DC is a homogeneous neoplasm, often spherical in shape, in the form of a doubling (duplication) of the wall of a hollow organ. The main methods for diagnosis of DC are upper gastrointestinal endoscopy (EGD), CT, MRI, and endosonography. The indications for surgical treatment of patients with DC are: rapid growth of neoplasms, localization in anatomically narrow places and functional sphincters, the presence of clinical symptoms in patients. This article presents a rare clinical case of a patient with a large duplication cyst of the gastric antrum close to pyloric zone with abscess formation in the cyst and obstruction of the gastric outlet.
Materials and methods: a 27-year-old man complained of nausea, a feeling of heaviness and discomfort in the epigastrium, and periodically vomiting food eaten. Examination revealed a large duplication cyst 5x6 cm in size with signs of gastric outlet obstruction and gastrostasis. Patient underwent partial resection of the stomach with a cyst using hybrid laparo-endoscopic approach.
Results: No intraoperative complications were observed. Postoperative period was uneventful. The patient was discharged on the 5th postoperative day. Endoscopic and X-ray control studies demonstrated a good motor-evacuation function of the stomach and pyloric patency. The duration of follow-up period is 18 months. Patient have no complaints.
Conclusion: The treatment strategy for duplication cysts directly depends on the correct examination using modern diagnostic methods, which allow to detect the possible complications. Optimization of minimally invasive technology through the introduction of a hybrid approach demonstrates the benefits of the combined use of laparoscopic and endoscopic techniques, decreasing the disadvantages of each method separately and ensuring the organ-sparing nature of the intervention.

Klatskin tumor is a perihilar cholangiocarcinoma of the lobar and common hepatic ducts (liver port cancer) which is localized proximally to the confluence of common hepatic and cystic ducts (before segmental hepatic ducts of the second order). Currently, photodynamic therapy (PDT) is recommended for the complex management of patients with inoperable extrahepatic cholangiocarcinoma because the discussed PDT technique significantly increases the life expectancy in comparison to the isolated palliative therapy.
A clinical case presented in the article demonstrates the effectiveness of PDT technique in case of cholangiocarcinoma of bifurcation of the common hepatic duct T4N1M1, Bismuth-IV in combination with external drainage of bile ducts in order to resolve the mechanical jaundice.
Conclusion. A significant effect of PDT application in a patient with inoperable Klatskin tumor is demonstrated. PDT included into the treatment of such patients increases their life expectancy versus the average survival rate in those having palliative therapy.

Purpose. To assess the effectiveness of standard and modified settings of the fujinon intelligent color enhancement (FICE) technology in the differential diagnostics of colon epithelial formations including their morphological type.
Description of clinical cases. The presented clinical cases demonstrate the effectiveness of FICE modified mode in the endoscopic diagnostics of superficial epithelial neoplasms of the colon. The proposed technique simplifies routine examination and allows to determine a malignization potential of colon epithelial neoplasms. It also allows to determine the morphological type of epithelial formations in the large intestine during endoscopic examination.
Conclusion. Fujinon intelligent color enhancement (FICE) technique in a modified mode makes the diagnostics of epithelial formations and selection of curative tactics more precise.