Adenomas of the major duodenal papilla are benign neoplasms, but due to their high tendency to malignancy, they must be removed. Currently, in the treatment of patients with adenomas of the major duodenal papilla, both surgical and various intraluminal endoscopic interventions are used. To select the optimal method of treatment, it is necessary to type adenomas of the major duodenal papilla, which provides for an accurate topical description of the tumor, taking into account the size, growth and spread to the walls of the duodenum, the terminal sections of the common bile duct and the main pancreatic duct. The endoscopic typing developed by us for adenomas of the major duodenal papilla (endoscopic classification) allows us to determine the most effective and safe method of surgical intervention for each type of neoplasm.

Barrett's esophagus is an acquired pathological condition that develops as a result of the replacement of the destroyed stratified squamous epithelium of the lower part of the esophagus with a cylindrical cell epithelium, which includes goblet cells and which occurs as a result of repeated action of damaging factors on the esophageal mucosa RESEARCH OBJECTIVE, To develop an algorithm for managing patients with an established diagnosis of Barrett's esophagus before the appearance of severe dysplastic changes in the esophageal mucosa, depending on the identification of epithelial transformation factors, in order to prevent the development of the oncological process. MATERIALS AND METHODS, The work was carried out at the Moscow Medical Center for the Development of the Barrett's Disease in the period from 2013 to 2023. The study was conducted both retrospectively and prospectively. CONCLUSIONS: 1. The course of the disease and the results are different in patients belonging to the same group and having the same morphological diagnosis; 2. The presence of mild dysplasia does not affect the treatment results; the greatest success in treating patients with BP, close to the indicators in the control group, was achieved in groups ia and iia, both in total indicators for the SDTS and in the proportion of failures; 3. The lowest indicators on the GerdQ and SDTS scale and the highest proportion of failures were in group ii, which means that these patients are at risk of neoplastic transformation of the columnar epithelium; 4. Gender characteristics have a statistically significant effect on the course of the disease: in women, the treatment results are better 93% > 50 points on the SDTS compared to 84% in men (p < 0.01); 5. Age characteristics have a statistically significant effect on the course of the disease, since there is a statistically significant difference in the success rates of treatment in patients under 50 years of age (p < 0.05); 6. High results of treatment of patients by SDC> 50 points are registered in patients with absence or simultaneous growth of expression of genes p53 and p63, as well as ki-67 in the range from 20 to 40%, the obtained data are statistically reliable p<0.05; 7. The adopted algorithm of diagnostics, treatment and dynamic observation in the studied groups of patients with BP, taking into account the identified factors of neoplastic transformation of columnar epithelium, allowed to achieve high total indicators by SDC, reflecting success in achieving the set goals of treatment, 92.6% of patients had indicators> 50.

A total of 123 patients with middle lobe syndrome were examined: 82 (66.6%) men and 41 (33.4%) women, aged 16 to 86 years. The examination included a complex X-ray examination of the lungs, bronchoscopy with various types of biopsies, followed by bacteriological, cytological and histological studies of the biopsy material. The following diagnoses were established: pneumonia - in 44 patients, chronic deforming bronchitis - in 49, lobe cirrhosis - in 2, bronchiectasis - in 2, central lung cancer - in 8, lung abscess - in 6, tuberculosis - in 3, benign tumors - in 4, foreign bodies - in 4, sarcoidosis of the respiratory system - in 1 patient. Based on the use of only radiation methods, it was possible to establish the nosological form of the disease in 105 patients (86.5%), and with the combined use of radiation diagnostic methods and bronchoscopy with various types of biopsies, followed by examination of the biopsy material, the correct diagnosis was established in 99.2% of patients, 1 patient had a diagnostic error (0.8%). Sanitation bronchoscopy was performed in 61 patients with chronic deforming bronchitis, bronchiectasis, lung abscess and foreign bodies (after their removal). In patients who received NO-therapy in the complex treatment, a significant decrease in the duration of treatment was noted.

Endoscopy nurse in a unique specialist in healthcare, combining duties of routine nurse work and professional assistance for doctors in performing high-technology endoscopic examinations and treatment procedures with modern endoscopic equipment. For now, endoscopy is not only routine examinations of upper and lower GI tract. Novel endoscopy is fast evolving with modern technologies, such as high definition narrow-band imaging, confocal laser endomicroscopy and endocytoscopy, providing up to 1000 times magnification of mucosa. Moreover, endoscopic treatment procedures - endoscopic mucosal resection, submucosal dissection, endoscopic stenting and many more are widely used for treatment of early cancers and palliative care. Endoscopic nurse assists physician in all these examinations and procedures. Furthermore, in some countries, endoscopy nurse performs easy endoscopic examinations by herself. In most countries, but not in Russia, endoscopic equipment reprocessing performed by dedicated technical staff, not by endoscopy nurse. Unfortunately, in Russian Federation, in compare to other countries, there is no endoscopy nurse certification or professional guidelines.

Diagnosis of the genesis of bile duct strictures is a complex task facing clinicians. The use of cholangioscopy, in particular, the SpyGlass system, is becoming increasingly relevant among oncological patients in case of unsuccessful attempts at previous morphological verification. The presented clinical case demonstrates the capabilities of cholangioscopy as a method of direct visualization of the duct system with the ability to perform a biopsy under vision control in the verification of such a pathology as primary sclerosing cholangitis. Primary sclerosing cholangitis is a rare disease of the biliary tract that requires a systematic approach to diagnosis. The primary task is to identify the etiology of strictures and early diagnosis of cholangiocarcinoma.

Eosinophilic esophagitis (EoE) is characterized by endoscopic signs and detection of more than 15 eosinophils per high-power field of view in biopsy specimens of the esophageal mucosa. Due to deep chronic eosinophilic inflammation, it can cause complications: esophageal stenosis, rarely perforation. Intramural esophageal dissection (IED) is a previously undescribed complication of EoE in children. We present a case of IED in a 15-year-old boy, which clinically manifested itself as sudden epigastric pain radiating to the back and nausea against the background of acute respiratory viral infection. According to endoscopy, CT and X-ray contrast study, a double-barreled esophagus with two cavities was detected - the esophagus itself and a blind "pocket", histologically in which granulation tissue and active inflammation with a large number of neutrophils were found. The initial histological examination did not reveal significant eosinophilic infiltration in the esophagus. The boy received a course of esomeprazole and was re-examined 6 months later. The radiographic picture was the same, and endoscopic examination revealed characteristic signs of EoE: longitudinal grooves and erosions, transverse rings, and narrowing of the esophageal lumen. In the middle third, the picture of a double-barreled esophagus was still preserved, but without signs of acute detachment, but with a dense septum between the two cavities of the esophagus. Histologically, the infiltrate contained more than 50 eosinophils in the field of view. The diagnosis was eosinophilic esophagitis complicated by RTI. A strict hypoallergenic diet was prescribed, excluding obligate allergens, budesonide 1 mg 2 times a day in the form of a gel. Endoscopic dissection of the esophageal septum was performed, its patency was restored. After 2 months, the boy was examined again while continuing drug therapy and diet. He had no complaints, radiologically the patency of the esophagus was not impaired. Endoscopically, the esophagus was freely passable, there was only a small fold at the site of the operation, longitudinal grooves and small erosions in the lower third remained. Histologically, the number of eosinophils decreased significantly. Therapy was continued. This clinical case demonstrates the possibility of developing RDI as a complication of EoE. The course of EoE can be asymptomatic, and RDI is the first manifestation of the disease. The endoscopic picture of a double-barreled esophagus is a consequence of dissection. The combination of a hypoallergenic diet, topical steroids and endoscopic septectomy is effective in the treatment of EoE with RDI.

The participation of nurses in the prevention of mental disorders and the possibility of increasing their contribution to the organization of this care is currently extremely relevant against the background of the participation of the medical community of the world in general, and the Russian Federation in particular, in the implementation of the achievement of sustainable development goals. Sustainable Development Goals (SDGs) were set by the UN for the period up to 2030 to solve the problems of global and national development. All UN members, including the Russian Federation, are implementing the SDGs to increase economic growth, social development in such sectors of the social sphere as education, healthcare, social protection and employment, as well as environmental protection. In total, 17 such goals have been formed at present. As part of this study, we analyze the participation of nurses in achieving the Goal "Ensure healthy lives and promote well-being for all at all ages", which is aimed at promoting a healthy lifestyle and promoting "well-being for all at all ages - important components of sustainable development" In this regard, a systematic approach to the early detection of states of psycho-emotional stress and the prevention of mental disorders is required. And a special role in this treatment and preventive activity is played by nurses of various specialties who work in outpatient, inpatient units, and provide primary, multidisciplinary and specialized care to the population. The development of nurses' competencies and, indirectly, the effectiveness of the functioning of a medical organization will be parts of a general system of measures that contribute to the prevention of mental disorders and an increase in the level of mental health.

The article is dedicated to the VI Eurasian Forum «UralEndo» held in Yekaterinburg in August 2022. Among the most actual topics of the forum this year were the issues of practical implementation in the practice of medical organizations at all levels, starting with primary care. The focus was on cancer screening, as well as the organization of the work of endoscopic units based on risk-oriented approaches in order to improve the safety and quality of endoscopic procedures for the patients benefits.