Purpose of the work. To determine the existing pathophysiological mechanisms in patients with critical conditions and, in particular, in patients with stroke during the period of chronicization of processes on the part of the respiratory tract and aspects of the work of doctors - endoscopists, as part of the multidisciplinary team involved in the treatment of this group of patients. Materials and methods. In accordance with the set goal, an analysis of the world literature was performed using the TripDataBase search system, which allowed to study and structure the main pathophysiological mechanisms observed in patients with “chronic critical conditions”. The obtained data were implemented in the work of the endoscopic department of the Federal State Budgetary Institution Federal Center for Medical and Biological Affairs of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing of the Russian Federation. Results. According to the analysis of the world literature, the most important factors in patients with chronic critical conditions who are in the departments of anesthesiology and resuscitation are respiratory distress syndrome and comorbidity. According to the results of practical work, the features of the endoscopic picture in this group of patients, based on our endoscopic observations, were as follows: erosive and ulcerative changes in the mucous membrane and tracheobronchial dyskinesia of stage II. As a result of the study, an endoscopic algorithm for managing this group of patients was presented, which demonstrated its clinical effectiveness and the results of its application will be presented in the following publications Conclusion. Rehabilitation for stroke during the period of chronicization of processes is carried out by a multidisciplinary team, in which the role of endoscopic methods of treatment has been proven by the clinical experience of using the developed algorithm.

The aim of the study was to evaluate the feasibility of using endobronchial ultrasound (EBUS-TBNA) for the diagnosis of unspecified lymphadenopathy, peribronchial lung neoplasms and mediastinal formations. A retrospective analysis of 339 EBUS-TBNA studies from 2021-2024 using an ultrasound bronchoscope followed by a fine needle aspiration biopsy was performed. The diagnostic accuracy of EBUS-TBNA was 80.3%. Non-squamous cell non-small cell lung cancer accounted for 45.6%, due to their highest percentages of mediastinal forms and lymphadenopathy. There were no clinically significant complications. EBUS-TBNA is an effective method of sampling for the diagnosis of mediastinal formations and peribronchial bronchial tumors for cytological and histological examination and has advantages over other verification methods, primarily for comorbid patients.

Aim. Demonstration of a rare clinical case of non-surgical treatment of a ruptured pulmonary hydatid cyst. The clinical signs and symptoms, diagnostics and methods of treatment of pulmonary hydatid cysts are discussed. Materials and methods, results. A 52-year-old patient underwent removal of a pulmonary hydatid cyst that had ruptured into the right upper lobe segmental bronchus using fiber-optic bronchoscopy. The intervention was successful, without any complications or remnants of the cyst membrane. During the follow-up period, the patient showed clinical and radiographic recovery, which made it possible to avoid surgery. Conclusion. The method of therapeutic fiber-optic bronchoscopy in some cases is an alternative to surgery in the treatment of patients with a ruptured pulmonary hydatid cyst.

The aim of study: The objective of the study was to evaluate the effectiveness of endoscopic bronchial valve placement in the treatment of patients with bronchopleural fistulas and prolonged air leaks of various etiologies. Material and methods: endoscopic bronchial valve placement was performed in 229 patients with bronchopleural fistulas or air leaks in the postoperative period (men - 188; women - 47). The patients’ age ranged from 14 to 73 years (mean 50.38±17.00 years). The patients were divided into 6 groups, depending on the nosology: operated on for bullous emphysema of the lungs, with acute purulent diseases of the lungs, including complications of COVID-19, with chronic purulent diseases of the lungs and pleura, with bullous emphysema of the lungs complicated by pneumothorax in whom it was not possible to achieve lung straightening during drainage of the pleural cavity, blocking for palliative purposes and other lung diseases, and in whom prolonged air discharge through the drains was noted after surgery. Results. There were no complications during the procedure. In most patients (180-78.6%), the installation of the valve led to the cessation of air leakage within 2-3 days. In 19 cases (8.29%), an additional blocker was installed or replaced with a larger one. The final blocking efficiency was 86.89% - 199 patients. In 6 patients, with a long-term (more than 4 months) valve placement cicatricial obliteration of the bronchus occurred, which was successfully treated by endoscopic methods. Conclusion. Endoscopic bronchial valve placement is a highly effective minimally invasive method of treating patients with various lung pathologies, which can be widely used in the practice of many thoracic surgery departments. Efficiency and its absence in patients with various diseases require further analysis and development of tactics with possible additional blockade or replacement of the valve with a larger one. Patients with endobronchial valve duration of more than 4 months should be included in the risk group for the development of cicatricial stenosis and obliteration of the bronchus.

The aim of the study: to evaluate the effectiveness of valve bronchial blockade in the complex treatment of complications of purulent-destructive non-specific lung diseases. Materials and methods: 110 patients with acute lung destruction, post-resection empyema, chest trauma complicated by bronchial fistulas were divided into two groups according to the method of treatment: Group 1 - patients who received valve bronchial blockade against the background of drug treatment; Group 2 - patients who received only drug treatment. Methods: clinical, radiological, endoscopic. The results are assessed as good, weak effect and no effect. Among patients in Group I with a good effect, there were 32.4% more than in Group II, the residual pleural cavity was eliminated 39.7% more often. Conclusion: Inclusion of valve bronchial blockade in the treatment complex of patients with the specified pathology allows achieving better results compared to patients who received only drug treatment.

Barrett’s esophagus, being a precancerous disease, increases the risks of adenocarcinoma development by several dozen times. In recent years, there has been an increase in the incidence of esophageal adenocarcinoma in a number of countries, which makes the problem of timely diagnosis of early neoplastic changes in the epithelium against the background of Barrett’s esophagus especially relevant. In the endoscopy department of the P. A. Herzen Moscow Oncology Research Institute, 760 patients were examined in 2012-2024, in whom Barrett’s esophagus was detected during upper GI endoscopy. The disease was detected in men 2 times more often than in women (526 vs 254). In more than half of the patients, we observed a long segment of BE metaplasia (55.3% [95% CI: 51.7%-58.8%]). Different types of epithelial neoplasia were detected in 177 examined patients, which accounted for 23% of the total number of patients with BE. It was found that the greatest number of be changes were detected within a long segment of metaplasia (74.5% [95% CI: 68.1%-80.9%]). In less than 24% of cases [95% CI: 17.4%-30.0%], lesions were found within the short segment of BE. Some patients (85.7%) underwent endoscopic removal of neoplasms, which was considered radical based on the results of a pathomorphological examination of surgical material. We identified several signs characteristic of mild and severe epithelial dysplasia, as well as non-invasive Barrett’s esophageal adenocarcinoma. We also described treatment strategies in case of detecting superficial neoplasms.

Since inflammatory diseases and precancerous lesions of esophagus require clinico-morphological diagnostics, it includes histological verification of endoscopic lesions in line with specific protocols of biopsy taking according to endoscopic findings and expected diagnosis. This review elucidates pathogenesis of gastroesophageal reflux disease (GERD) specter and focuses on detailed features of histologic diagnostics of Barrett’s esophagus and Barrett’s dysplasia. Precise histologic diagnosis in this group of patients implies appropriate treatment and defines prognosis.

Aim. Analysis of the results of using laparoscopic technologies in the city clinical hospital named after N.I. Pirogov in Orenburg Materials and methods. A retrospective analysis of all elective of emergency laparoscopic surgeries performed in the city clinical hospital named after N.I. Pirogov in Orenburg for 2020-2024 years. Results. During the period 2020-2024, 3,541 laparoscopic surgeries were performed, of which 1240 were elective (35.1%), and 2,301 were emergency (64.9%). Laparoscopic operations accounted for 67.3% of all performed surgical procedures. Emergency operations accounted for the majority of the interventions. There is an annual increase in the percentage of laparoscopic surgeries performed, and new techniques and equipment are being explored, such as bariatric and anti-reflux surgery. Conclusion. Laparoscopy in general surgery has proven to be an advantage over open surgery in planned and emergency operations. There is a decrease in the number of postoperative complications and mortality as a result of an increase in the proportion of laparoscopy.

Aim. Analysis of the results of using laparoscopic technologies in the city clinical hospital named after N.I. Pirogov in Orenburg Materials and methods. A retrospective analysis of all elective of emergency laparoscopic surgeries performed in the city clinical hospital named after N.I. Pirogov in Orenburg for 2020-2024 years. Results. During the period 2020-2024, 3,541 laparoscopic surgeries were performed, of which 1240 were elective (35.1%), and 2,301 were emergency (64.9%). Laparoscopic operations accounted for 67.3% of all performed surgical procedures. Emergency operations accounted for the majority of the interventions. There is an annual increase in the percentage of laparoscopic surgeries performed, and new techniques and equipment are being explored, such as bariatric and anti-reflux surgery. Conclusion. Laparoscopy in general surgery has proven to be an advantage over open surgery in planned and emergency operations. There is a decrease in the number of postoperative complications and mortality as a result of an increase in the proportion of laparoscopy.

Objective: to present clinical cases and a literature review of a rare pathology- tracheal chondrosarcoma. Materials and methods. The data of endoscopic examinations conducted in a planned and emergency manner, data from morphological examination of biopsy material, as well as data from radiation research methods are presented. Results. Stenting of the trachea in emergency conditions, repeated correction of the displaced stent in conditions of using only flexible endoscopy made it possible to correct the patient's critical condition, conduct the 1st stage of inpatient treatment, and transfer to outpatient treatment for chemotherapy at the place of residence. Conclusion. According to Russian scientists, mediastinal mesenchymal tumors account for only 5% of the total number. Tracheal chondrosarcoma is an exceptionally rare, poorly studied nonepithelial (mesenchymal) tumor of the mediastinum. According to foreign literature, from 1959 to 2021, only 36 cases of tracheal chondrosarcoma were described. This case is 37. Diagnosis of tracheal chondrosarcoma is difficult, since conventional chest X-rays often do not reveal pathology. Patients have been treated for bronchial asthma or bronchitis for many years. Thus, the presented clinical case demonstrates the role of endoscopy in the diagnosis and treatment of a rare mesenchymal tumor in a patient with long-term pulmonological symptoms that do not respond to conservative treatment with further transition to outpatient treatment, including chemotherapy.

Clinical cases with magnetic foreign bodies of the gastrointestinal tract in children, diagnostic features, and the importance of timely endoscopic treatment are presented.

The article presents a clinical case of successful endoscopic treatment of gastric trichobezoar in a 13-year-old girl. During endoscopy, there was a 5x8 cm foreign body (trichobezoar) in the stomach. Repeated attempts to fragment and extract the foreign body with endoscopic loops, forceps and endoscopic scissors proved unsuccessful due to the high density of the trichobezoar. Using an endoscopic knife for submucosal dissection, the trichobezoar was divided into small fragments that were successfully and safely extracted from the lumen of the stomach.

Goal: To analyze the changes in the regulatory framework for organizing medical facilities for endoscopic examinations, effective from 2025, and to demonstrate their significance for medical organizations, as well as possible ways to adapt to the new requirements. Materials and methods: The study is based on the analysis of regulatory documents: the Order of the Ministry of Health of the Russian Federation dated April 14, 2025, No. 206n - effective from September 1, 2025; the Order of the Ministry of Health and Medical Industry of the Russian Federation dated May 31, 1996, No. 222; the Order of the Ministry of Health of the Russian Federation dated December 6, 2017, No. 974n; and sanitary rules SP 2.1.3678-20. A comparative analysis of changes in the list of mandatory premises and requirements for their justification, design, and operation was conducted, along with the consideration of practical examples of the impact of these changes on the work of medical personnel and the organization of endoscopic departments.

Goal. To analyze the changes in standards for equipping endoscopic rooms introduced by the Order of the Ministry of Health of Russia No. 206n dated April 14, 2025, with an emphasis on the importance of using medical device codes, and to assess the impact of these changes on the quality, safety, and control of medical equipment in healthcare organizations. Materials and methods. The study is based on the analysis of regulatory documents: the Order of the Ministry of Health of the Russian Federation dated 14.04.2025 No. 206n, the Order dated 31.05.1996 No. 222, and sanitary rules SP 2.1.3678-20. A comparative analysis was conducted to assess the impact of standardization on procurement processes, technical maintenance, and patient safety, as well as an analysis of equipment requirements for endoscopic rooms before and after the introduction of the order. A review of practical recommendations and potential risks associated with the use of equipment with different codes was also performed.