[Innovative endoscopic technologies in multi-field medical facility]. / Innovatsionnye éndoskopicheskie tekhnologii v mnogoprofil'nom uchrezhdenii.

The modern clinical practice is characterized by intensive introduction of innovative technologies for improving treatment and diagnostic procedures, minimizing their impact on the patient, complications rate and economic reasons. One of the priorities in this area is both diagnostic and therapeutic endoscopy. The degree of practical use of innovative endoscopic technologies depends on not only the quality of care, but also their economic reasons. Endoscopic treatment has become the method of choice for gastrointestional bleeding, extraction of foreign bodies, obstructive jaundice, polyps of the gastrointestinal tract, achalasia, esophageal strictures, etc. So, the current state of scientific and technical advances have made minimally invasive surgical intervention one of the main direction of development of surgery. The further improvement will be considered integration of minimally invasive and information technologies. The widespread introduction of minimally invasive surgical techniques in clinical practice indicates their undoubted efficiency and availability, especially in the multidisciplinary hospitals that provide various types of specialized high-technological medical care. This allows to embody the principle of multidisciplinary and personalized approach in the treatment of patients. The main result of such practices is to reduce the duration of inpatient treatment, a significant reduction in the degree of invasive impact and risk of surgical interventions, diagnostic interventions and operations in a 'one-day hospital', with a total increase of efficiency of surgical treatment, and with high quality of life of patients.

[The experience of biliary self-expendable nitinol stents for malignant jaundice].

THE AIM: to analyze the effectiveness and possible complications of endoscopic biliary drainage (BD) using self-expanding metal stent (SEMS) in patients with malignant jaundice (MJ). METHODS: From January 2010 to January 2014 in endoscopy department of Pirogov National medical and surgical Center were operated 64 patients with MJ, 38 of them with SEMS. The average patient's age was 65.4 ± 14.5 years. The mean duration of jaundice was 13 ± 5.4 days before drainage. The remaining 6 patients (15.8%) were operated with preliminary PTBD. In all 38 patients were diagnosed unresectable tumors. RESULTS: successful endoscopic BD were achieved in all 38 patients. 35 patients were drained with transpapillary SEMS and 3 patients with EUS-guided choledochoduodenoanastomoses (EUS-CDA). Early postoperative complications were observed in 3 (7.8%) patients with no lethality. CONCLUSION: endoscopic BD with SEMS is an effective method of internal drainage for inoperable pancreatobiliary tumors, providing adequate BD for the entire duration of life expectancy. In case of failed transpapillary drainage EUS-guided biliodigestive anastomoses were performed. The complication rate of endoscopic BD in patients with malignant pancreatobiliary tumors in our study was 7.8% and comparable with complication level due to ERCP/EST for benign pathology.

[The prevalence and clinical aspects of Barrett's esophagus in the population of Eastern Siberia].

AIM: To study the prevalence and clinical aspects of Barrett's esophagus (BE) in natives and newcomers in East Siberia. SUBJECTS AND METHODS: Clinical examinations and esophagogastroduodenoscopy were performed in 12975 Caucasoids and 1489 Khakases in Abakan (Khakasia), 1861 Caucasoids and 5829 Tuvinians in Kyzyl (Republic of Tuva), and 1177 Caucasoids in Dudinka (Taimyr). The diagnosis of BE was verified by morphological study. RESULTS: Among the Caucasoids, the total prevalence of BE was 1.6% (2.4% in men and 0.8% in women; odds ratio (OR) was 3.21 with 95% CI 2.40-4.29; p < 0.001); among the Mongoloids, that was 3.1% (4.5% in men and 2% in women; OR, 2.3 with 95% CI 1.75-3.04; p < 0.001). Heartburn and other typical symptoms was more prevalent in patients with BE. The risk factors of BE in all the examined populations were male sex, age over 40 years, smoking more than 20 cigarettes a day for 10 years or more in men, and obesity. CONCLUSION: There were ethnic differences in the prevalence of BE, which were prevalent in East Siberia in the Mongoloids as compared to the Caucasoids.

[Peculiarities of relationship between atrophic gastritis and stomach cancer in the population of Eastern Siberia].

The authors studied the prevalence of atrophic gastritis, H.pylori strains carrying the CagA gene, seeding and apoptosis indices of gastric mucosa in indigenous and newcomer residents of Evenkia. A total of 136 Evenks and 159 newcomers were examined using fibrogastroscopy and biopsy of antral gastric mucosa. Morphological study included light microscopy of hematoxylin and eosin-stained biopsies and their analysis using a visual-analog scale to reveal signs of inflammation, apoptosis, intestinal metaplasia and the degree of insemination by P. pylori. Urease and morphological tests were used to identify H. pylori and the TUNEL technique (Mebstain Apoptosis kit direct, France) to determine apoptosis index; serum anti-Helicobacter and CagA antibodies were detected by an immunoenzyme assay in 22 Evenks and 24 newcomers with chronic H. pylori-associated gastritis. The prevalence of atrophic gastritis in these groups was estimated at 13.2 and 23.9% respectively, seeding density 45.37 +/- 2.01 and 214 +/- 8.75 (p < 0.001). H. pylori strains carrying the CagA gene were identified in 59.6 and 43.6% of the newcomers and Evenks (p = 0.01), total apoptosis index in greater curvature mucosa was 4.99 +/- 0.23 and 3.19 +/- 0.28 (p < 0.01) respectively. These ethnic difference in the prevalence of atrophic gastritis appear to be attributable to different intensity of apoptosis in greater curvature mucosa.