
Scientific and Practical Peer-Reviewed Medical Journal for Specialists in Radiology, Endoscopy, Surgery, and Other Related Fields. The journal is dedicated to scientific issues in endoscopy and radiology, including topics in experimental and clinical medicine, scientific reviews and lectures for practicing physicians, case studies from clinical practice, as well as information about the latest scientific forums in Russia and abroad on major issues in radiology and endoscopy.
Current issue
Vol 67, No 1 (2025)
EDITORIAL
CLINICAL ENDOSCOPY
LEADING ARTICLE
Organ-sparing and functionally-sparing hybrid endoscopic surgeries in gastrointestinal tract surgery
Yu. G. Starkov,
A. I. Vagapov,
S. V. Dzhantukhanova,
R. D. Zamolodchikov,
I. T. Amaliev,
P. Sh. Arabova,
D. D. Avdeeva
17-25 60
Abstract
Hamartoma polyps are benign epithelial The application of laparoscopic-endoscopic hybrid techniques in the treatment of patients with non-epithelial tumors of the upper gastrointestinal tract, early gastric cancer, and cholelithiasis complicated by choledocholithiasis and stricture of the terminal part of the common bile duct allows, through the combination of endoscopic and laparoscopic manipulation capabilities, to achieve optimal functional-sparing and organ-preserving results. At the same time, this approach helps to minimize the risks of postoperative complications and functional disorders, as well as to reduce the length of hospital stay. It should be noted that the performance of hybrid surgeries is only possible in specialized centers with a high level of specialists and the necessary equipment, as well as with developed interaction between endoscopic and laparoscopic teams.
GASTROENTEROLOGY
26-33 514
Abstract
Objective. To identify the features of endoscopic anatomy of the esophagogastric, gastroduodenal and ileocecal junctions to improve diagnostics and treatment of diseases of these sections. Materials, methods. The study material was: • middle-aged and elderly men and women without diseases of the esophagogastric (EGJ), gastroduodenal (GDP), ileocecal (ICP) junctions in 110, 208 and 97 people, respectively; • macropreparations of the EGJ from 70 people who died from diseases not associated with pathology of the gastrointestinal tract (GIT); • capsule endoscopy in 104 patients. Methods: clinical, endoscopic, radiological, anatomical. Endoscopic methods: traditional flexible endoscopy with Olympus video endoscopes (Japan) and capsule endoscopy with PillCam Colon2 capsule (Israel). Results. The combination of methods used in the study of 3 transition zones of the gastrointestinal tract allowed us to identify: • the presence of columnar epithelium in the esophagus, which is a variant of the norm and facilitates the diagnosis of Barrett’s esophagus; • creation of a duplicate in the esophagus from flat and underlying columnar epithelium when they are connected, which requires a step biopsy or clarifying endoscopic methods to exclude precancerous changes in the mucous membrane or adenocarcinoma; • transition of the gastric mucosa through the pylorus into the bulb of the duodenum, which dictates the need to exclude preneoplastic changes in these areas; • circular fold around the opening of the bulbous side of the pylorus, which may be one of the antireflux mechanisms of the GDP; • feature of the location of the appendix opening, the predominant shape and number of folds of the dome of the cecum, the shape of the Bauhinia valve. Conclusion. The identified features of the transitional zones of the gastrointestinal tract contribute to the improvement of the diagnosis and treatment of their diseases. Capsule endoscopy is a method that allows studying the endoscopic anatomy of transitional zones and examining hard-to-reach zones of the gastrointestinal tract. With the help of capsule endoscopy, a circular fold around the opening of the bulbous side of the pylorus was discovered for the first time, which may be one of the antireflux mechanisms of the gastroduodenal junction.
34-40 257
Abstract
The purpose of this article is to demonstrate the experience of the Astrakhan Regional Clinical Oncology Dispensary in diagnosing intramural metastasis of tumors of the esophagus and prostomial parts of the stomach, as well as to emphasize the importance of correctly assessing the extent of tumor damage to determine further treatment tactics. Materials and methods. 630 endoscopic examinations were performed on 570 patients with malignant tumors of the esophagus and proximal parts of the stomach with transition to the area of the esophagogastric junction and esophagus (ICD-O-3 C15.0, 3-5, C 16.0) Results. The endoscopic picture of intramural metastases is diverse, but most often they were multiple or single elevated or flat-elevated neoplasms with a submucosal location, a predominant size of 3-5 mm, mainly with clear contours, grayish-pink or grayish-yellow color, dense consistency. Conclusion. Detection of intramural metastases affects the determination of disease staging and, accordingly, the development of treatment strategy.
41-47 50
Abstract
Esophageal lichen planus (ELP) is rare and the least studied, data on this disease in the literature are presented mainly in the form of clinical observations and analysis of series of cases. Typical clinical manifestations include dysphagia and odinophagia. ELP can be associated with serious complications: stenosis and esophageal squamous cell carcinoma. Endoscopic examination reveals characteristic signs in the esophagus: swelling, thickening and increased vulnerability of the mucosa, often with fibrin, formation of membranes and strictures. The most specific histological sign is the presence of apoptotic Civatte bodies. Recommendations for the treatment of ELP are limited to the results of a series of clinical observations and include the prescription of systemic corticosteroids, noncorticosteroid immunosuppressant medications. The issue of supportive therapy is the least studied.
48-53 55
Abstract
Introduction: Neuroendocrine tumors (NETs) of the gastrointestinal tract have increasingly been diagnosed in clinical practice in the last decade. The stomach is one of the most common locations for NETs (g-NEN), which account for less than 2% of all gastric neoplasms with an increasing incidence worldwide. The recent increase in the incidence of g-NEN is partly due to the widespread introduction of modern video endoscopes into clinical practice. g-NENs are often diagnosed incidentally during endoscopy and, as a rule, macroscopically look like common gastric polyps. Today, various endoscopic methods are used in the treatment of g-NEN, which in most cases are radical. Since g-NEN type M is the most common, a conservative approach based on endoscopic mucosal resection (EMR) with subsequent observation is preferable to surgical intervention for small neoplasms with a diameter of no more than 5 mm that do not infiltrate the muscularis mucosa. Endoscopic ultrasound (EUS) was recommended for lesions > 10 mm to determine the exact depth of tumor infiltration, to assess regional lymph node involvement and thus to confirm the appropriateness of EMR. The aim of this publication: was to describe our experience in the treatment of gastric carcinoid syndrome using endoscopic polypectomies, submucosal resections, both as independent methods and in combination with argon plasma coagulation (APC) and photodynamic therapy (PDT). Materials and methods: from January to December 2024, we performed 48 endoscopic interventions for gastric carcinoids. Results: Of these, 12 patients underwent removal of formations by polypectomies, 10 patients underwent endoscopic resections with simultaneous APC of small carcinoid areas, and 28 patients underwent submucosal dissections. In two patients, PDT was additionally performed in the post-manipulation period after submucosal dissections, since the resection zone was performed along pathological tissues. No complications were noted during the manipulations and in the post-manipulation period. Tumor removal was performed with a preliminary injection of saline with adrenaline or hyaluronic acid solution. After R0 EMR type Ì g-NEN, follow-up with upper gastrointestinal endoscopy was recommended every 6-12 months for the first three years and annually thereafter; after EMR type II or IIIg-NEN, annual follow-up was recommended. Conclusion: NEO (g-NEN) of type I and type II stomach have a low potential for metastasis. Type III gastric NEOS are usually more aggressive than types I and II, and are often metastatic at the time of diagnosis with an overall 5-year survival rate of 50% [1]. Given the increasing incidence and prevalence of NEO (g-NEN), gastroenterology, endoscopists will encounter NEO throughout their professional careers. Determining the exact stage of NEO is crucial for evaluating and treating a patient, as well as for understanding the overall prognosis of the disease. Many stomach diseases can be successfully treated by gastroenterologists and oncologists in close collaboration with experienced endoscopists.
E. A. Drobyazgin,
Yu. V. Chikinev,
A. V. Korobeynikov,
A. S. Polyakevich,
I. V. Peshkova,
S. G. Stofin
54-59 227
Abstract
The aim of the study - evaluation of the effectiveness and possibility of using endoscopic gastrostomy to ensure long enteral nutrition. Materials and methods. For the period from 2004 to 2023, 125 patients aged 16 to 89 years (average 65.23 years) underwent endoscopic percutaneous gastrostomy in the clinic (68 men, 57 women). The majority of patients (105-84%) were patients with brain pathology, impaired consciousness and swallowing. Absolute indications for the intervention were impaired swallowing function, severe patient condition requiring long-term enteral nutrition including for chemotherapy or radiation therapy (10-16% of patients), preoperative preparation (2 patients with stage IV esophageal achalasia for up to 8 months and 2 patients with Zenker’s diverticulum for 2 months). Results. Endoscopic gastrostomy was inserted in all patients. No complications were observed. Preliminary dilatation of the lumen of the esophagus and (or) pharynx by bougienage along the guidewire to No. 36-40 Fr was performed in 10 (8%) patients with tumor stenosis. In the early postoperative period 6 (4,8%) patients had complications: postoperative wound suppuration in 4, abdominal phlegmon in 2, in periods longer than 14 days in 9 (7.2%): bumper syndrome in 7, gastrostomy tube prolapse in 2 patients. Conclusions. Endoscopic gastrostomy is an effective and relatively safe method of providing enteral nutrition due to its low trauma. Indications for the intervention may be diseases and traumatic brain injuries with swallowing disorders, neurological disorders (apallic syndrome), head and neck tumors for the purpose of special treatment. This technique can be used for preoperative preparation in patients with neuromuscular diseases of the esophagus. Gastrostomy tube can be removed at the end of the treatment course and/or resumption of swallowing. It is necessary to follow the rules for gastrostomy care after the patient is discharged from the hospital to prevent complications associated with long-term presence of the gastrostomy.
60-62 42
Abstract
This article presents the results of surgical treatment of patients with cholelithiasis for the period 2023-2024 on the basis of the Regional Hospital No. 3 in Tobolsk, and provides options for developing measures to improve the quality of medical care for this category of patients. The need for further implementation of minimally invasive technologies and increasing the availability of planned treatment to reduce the number of emergency operations was confirmed.
COLOPROCTOLOGY
63-69 47
Abstract
Objective. Determine barriers to colorectal cancer (CRC) screening before colonoscopy in patients. Materials and methods. We conducted a prospective, open-label cohort study at a single center, involving 200 patients from the endoscopic department between June 2020 and January 2024. Patients were divided into two groups: those undergoing colonoscopy with sedation (n = 100) and those without sedation (n = 100). We conducted a questionnaire of patients about the reasons for colonoscopy and an analysis of the most difficult period of the study depending on procedural sedation (PS). The intensity of the pain syndrome was assessed using a numerical rating scale (NRS). Patient satisfaction with the study was estimated on a ten-point scale. The percentages were compared using Pearson’s χ2 criterion. For quantitative measures not normally distributed, the Mann - Whitney U-test was used to compare the two groups. Results. Abdominal pain during primary and repeated colonoscopies without sedation, fear of general anesthesia, lack of awareness of patients about the indications of colonoscopy with sedation and financial difficulties are among the barriers to CRC screening before colonoscopy. The pain level in the patients of the group without sedation was 5.00 (3.00-6.00) points according to NRS. The satisfaction of patients in the PS group was 100%. Patients in the sedated group expressed their readiness to undergo a second colonoscopy under conditions of drug-induced sleep. Conclusion. Fear of pain is one of the main barriers to CRC screening in patients before primary and repeat colonoscopies. Patients with chronic diseases, insufficient social support, fears, and fatalists need medical consultations and the elimination of screening barriers. Patients’ awareness of colonoscopy insurance is one of the effective motivating factors.
70-76 38
Abstract
The article is devoted to the problems of informatization of the endoscopic service both in terms of helping a specialist during the examination process and in terms of saving, annotating and analyzing endoscopic photo and video images. The approaches to the use of the AI assistant based on computer vision ArtInCol are described, helping a specialist not to miss epithelial formations and reduce the likelihood of interval cancer. The functions of the compatible endoscopic archive Legendo are presented, which include saving, viewing photo and video materials of endoscopic studies, viewing video broadcasts, writing and editing a protocol in a structured or free form, viewing statistics on completed studies in real time. New opportunities that appear in the endoscopic service when using modern approaches to informatization are indicated: quality control, replication of expertise.
CLINICAL CASES
77-81 110
Abstract
Transpapillary peroral cholangioscopy, first performed in the 1970th, has become widespread over the past decade. Modern technical improvements, including high-quality imaging, have led to a renaissance of the technique, which now offers the possibility of performing a wide range of not only diagnostic but also therapeutic procedures. In this review, we present a clinical case of the use of electrohydraulic lithotripsy in transpapillary peroral cholangioscopy, focusing on the technical possibilities of its clinical use.
82-89 486
Abstract
Menetrier’s disease is a rare gastric disease of unspecified etiology, which was named after the French physician Pierre Eugène Menetrier, who described the pathology in 1888. The disease belongs to the group of orphan diseases, the ethology and pathogenesis of which remain unknown to this day. In the history of medicine, slightly more than 300 cases of this nosological unit have been described. The clinical picture of the disease has no pathognomonic symptoms, as a result of which diagnostic errors and, accordingly, treatment errors may occur, often leading to a protracted and severe course of the disease. This article presents our own clinical observation, during which, as a result of a long diagnostic search, the patient was given a final diagnosis - Menetrier’s disease.
90-93 70
Abstract
Lipomas localized in the Bauhin’s valve area can reach large sizes and be accompanied by such clinical symptoms as abdominal pain, intestinal obstruction, bleeding. We present a case of a 63-year-old female patient with pain syndrome in the right iliac region, in whom a large lipoma of the ascending colon was detected during an outpatient examination. After additional examination, endoscopic removal of a giant lipoma originating from the lower lip of the Bauhin’s valve was performed in our clinic using endoscopic submucosal dissection (ESD) with a good result. A special feature of this case was the possibility of endoscopic removal of a large-sized tumor due to a balanced approach, consistency of decision-making, and effective use of gravity when changing the patient’s body position during surgery.
NURSING
94-98 61
Abstract
In the modern world, the position of a nurse in endoscopy is growing and changing significantly: she becomes a doctor’s assistant during surgical interventions. The relevance of this topic is due to the fact that pancreatobiliary interventions are a complex, potentially lengthy procedure and the role of a nurse during retrograde halangiopancreatography. (ERCP) is extremely large and responsible. At the current moment of development of the endoscopic society of nurses, there is an obvious problem of lack of skills and understanding of the importance of their role in the endoscopic X-ray operating room. Many nurses do not realize the volume of increased workload and increased level of involvement in the process that occurs during minimally invasive surgical interventions. A nurse during pancreatobiliary interventions becomes a full-fledged assistant to a doctor and in addition to long-familiar duties, responsibility for the outcome of the manipulation falls on her shoulders. A nurse must know all the instruments, materials, PPE and solutions that are involved in retrograde interventions. The variety of endoscopic instruments is growing every day, as are their capabilities. In addition to knowledge of the instruments, a nurse must improve her skills and knowledge as an assistant to a doctor. Work in an endoscopic X-ray operating room is complex and painstaking. The article discusses the main aspects of a nurse’s work during ERCP, including equipment preparation, patient positioning, use of personal protective equipment (PPE), and interaction with a doctor. Nurses should pay special attention to improving their qualifications. A nurse must understand that the outcome of the surgical intervention and the patient’s further condition depend on her actions.
99-103 48
Abstract
The article shows the problems of water preparation issues and the importance of having water purification systems for rinsing endoscopes during the processing cycle. This fulfillment of conditions is very important in maintaining patient safety and maintaining the operability of endoscopes. Features of the composition of water in impurities, sediments and pollutants associated with a large number of subjects of the Russian Federation, their diversity of terrain and climate. Increased need for endoscopic services in gastrointestinal tract examination and treatment, increase in flexible endoscope fleets. Common technologies for mechanical water purification and their features are presented. The importance of the quality of washing off detergents and disinfectants is indicated. Necessary additions when using water treatment systems, as well as the conditions for their control, are noted.
EVENTS
ANNIVERSARY
ISSN 2415-7813 (Print)