1. Peoples’ Friendship University of Russia, Institute of Medicine (Moscow, Russian Federation)

Keywords:malignant dysphagia,malignant esophageal stenosis,esophageal stenting,self-expanding metal stents,SEMS

Abstract:Aim: retrospective analysis of the results of stenting versus surgical gastrostomy in patients with malignant dysphagia. Material and methods: 172 patients underwent endoscopic stenting (107) or surgical gastrostomy (65). Level of stenosis: esophagus (70/48), gastric cardia (32/16), esophagogastro- or esophagojejunoanastomoses (5/1). 109 self-expanding metal stents were implanted in 107 patients; 63 Cader and 2 Witzel gastrostomies were performed in surgical group. Results: Stents were successfully inserted in all patients. Early complications were observed in 11 (10,3%) patients after stenting and in 10 (15,4%) after surgical palliation, p=0,2246. In-hospital mortality was 4,7% (5 patients) after stenting and 33,8% (22 patients) after gastrostomy, p<0,0001. Mean hospital stay was 13 days (quartile range 9-17) in stenting group and 15 days (quartile range 12-20) in surgical group, p=0,0040. There was no statistically significant difference in long-term results, neither in late complications (p=0,2212), nor in survival (p=0,0829). Conclusion: Endoscopic placement of self-expanding stents is an effective method of restoration of oral intake in patients with malignant dysphagia. Stenting is associated with equal rates of early and late complications, lower mortality and decreased in-hospital stay as compared with surgical gastrostomy, and therefore may be recommended as a final palliation in inoperable patients.

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Full text is published :
Davydova S.V., Fedorov A.G., Klimov A.E. ESOPHAGEAL STENTING VERSUS GASTROSTOMY IN PATIENTS WITH MALIGNANT DYSPHAGIA. Experimental and Clinical Gastroenterology Journal. 2016;128(04):13-19
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1. Clinical hospital № 61 (Moscow, Russian Federation)
2. Sklifosovsky Research Institute for Emergency Medicine (Moscow, Russian Federation)

Keywords:colonic bleeding,colonoscopy,endoscopic hemostasis,polypectomy

Abstract:For 3 years at the Research Institute of Emergency Care by NV Sklifosovsky received 174 patients with clinical bleeding from the lower gastrointestinal tract. The first group included 76 patients (43.7%) with confirmed at colonoscopy bleeding, the second - 98 patients (56.3%) with no signs of bleeding. Research has shown that the structure of colonic hemorrhage in recent years has changed. If you have previously most often the source of bleeding is cancer and colon diverticula, now the leading source of bleeding is erosive or hemorrhagic colitis. Endoscopic hemostasis was performed in 5.2% of patients, and electroexcision of the polyps - at 9.2%.

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Full text is published :
Pinchuk T.P., Kononenko N.S., Sogreshilin S.S. ENDOSCOPIC DIAGNOSIS AND TREATMENT OF COLONIC BLEEDING. Experimental and Clinical Gastroenterology Journal. 2016;128(04):20-23
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1. Riga Stradins University, Department of Pathology (Riga, Latvia)
2. Riga East Clinical University Hospital, Pathology Centre (Riga, Latvia)
3. Riga Stradins University, Department of Internal diseases; Riga East Clinical University Hospital, Gastroenterology, Hepatology and Nutrition clinic (Riga, Latvia)

Keywords:upper gastrointestinal tract,bleeding,diagnostic errors,co-morbidities

Abstract:Background. Endoscopists, surgeons and gastroenterologists have emphasized the importance of bleeding from oesophageal varicose veins, stomach and duodenum peptic ulcers and malignancies of this region, but less attention has been paid to the role of gastric erosions. Upper gastrointestinal bleeding (UGIB) may happen not only due to primary pathologies of UGI organs but also in case of different concomitant non-oncological and oncological pathologies. Possibilities of autopsies are the detection of real cause of death and misdiagnosed cases with gastrointestinal bleeding. Aim of the study. To analyse UGIB autopsy cases with different co-morbidities. Methods. We have investigated 120 cases of death from UGIB during the period of 2013-2014. Clinical information and laboratory analyses were obtained from the hospital electronic database. Pathology protocols and histological specimens stained with haematoxylin-eosin were analyzed. Diameter, depth and the total area of erosions were evaluated. We focused as well as on the site of death of the patient: whether it happened in hospital or outside it. Risk factors for UGIB were counted by Rockall numerical scoring system but Forrest scale was used for bleeding evaluation. Results. Patients were divided into two groups: 1) the patients, who died of profuse bleeding in connection with the upper digestive organ pathology (n=84), 2) the patients with bleeding developed mostly from erosions as a different disease complication (n=36). The main causes of fatal bleeding of I group persons were: gastric ulcer -38.1%, duodenal ulcer -11. 9%, oesophageal varices -30.9%. 28% of patients had such co-morbidities as: liver steatosis, different localization atherosclerosis and chronic forms of coronary heart disease, chronic pulmonary emphysema and nephrosclerosis. Rockall score was 4. Main illnesses of the II group of patients in case of secondary bleeding from gastric erosions were general atherosclerosis, cardiac pathologies with cardiac failure, chronic pulmonary diseases and non gastric malignancies. In contrast, the duodenal erosions were mostly found in chronic alcoholics with simultaneous pancreas and liver damage. Number of erosions in the stomach and duodenum ranged from 7 to 20. The average value of erosion diameter was 4.7 ± 1.3 mm. Rockall score was 8. Gastric and duodenal tissue tests confirmed the diagnosis of hemorrhagic erosive gastritis and duodenitis. The main diagnosis in this group of patients was correct in 84% of cases, but clinical information about gastric or duodenal bleeding was very insignificant.100 ml to 1.5 litres of blood was found in the stomach in both groups of patients. 29% of all patients died at the stage before hospitalisation. 48% of the patients were in the hospital from a few hours to 1 day. Conclusion. The improvement of the diagnostics of UGIB restricts delays in hospitalization, people low level of responsibility for their own health and insufficient information from family doctors about the patient background chronic diseases.

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Full text is published :
Kleina R., Nazarovs Ju., Derovs A. UPPER GASTROINTESTINAL BLEEDING IN FATAL CASES WITH DIFFERENT CO-MORBIDITIES. Experimental and Clinical Gastroenterology Journal. 2016;128(04):24-29
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1. City Clinical Hospital № 29 (Novokuznetsk, Russian Federation)
2. Novokuznetsk State Institute of Postgraduate Medicine (Novokuznetsk, Russian Federation)

Keywords:endoscopic papillotomy,acute biliary pancreatitis,papilla morphology,morphology of duodenal mucous

Abstract:The aim of this study was to evaluate the morphological changes in the duodenum at acute biliary pancreatitis and after cholecystectomy and their influence on the frequency of EPST use at acute biliary pancreatitis. Materials and methods. Multicentre cohort study. A retrospective analysis of medical records of 535 patients with proven biliary pancreatitis from 2007 to 2013. Men - 212 (39.63%), 323 women (60.37%). The average age of 54,83 ± 14,17. The prospective study in 2013-2015 included similar 100 patients, mean age 59,27 ± 16,66 years. Duodenoscopy performed in all patients during the first 4 days. All of these patients underwent biopsy of duodenal mucosa near the papilla Vater. For comparison, 34 morphological studies performed of zone papilla Vater in patients with cholelithiasis after papillotomy. 28 women (82.3%), 6 males (17.7%) aged 25 to 82 years. Statistical analysis performed using the software Statistica 6.0 and SPSS19.0 Results. Frequency of EPST at acute biliary pancreatitis was 16.9%. In a retrospective analysis of the most significant causes of EPST were papillitis (φ = 0,950), functional stenosis of papilla (φ = 0,643), cicatrical stenosis of papilla (φ = 0,299) and obstruction of papilla by stone (φ = 0,299). In a prospective study dominated cicatrical stenosis of papilla (φ = 0,783) and obstruction of papilla by stone (φ = 0,446). Morphological studies of duodenal mucosa showed significant dependence of expression of morphological changes from the severity of acute biliary pancreatitis. Morphological assessment of papillae revealed the prevalence of chronic inflammatory changes, but the frequency of involvement in the inflammation of the deep layers were similar (18% vs. 15%). Conclusion. Frequency of duodenal inflammatory changes and inflammatory changes of papilla are connected among themselves. Endoscopic signs of duodenitis and papillit with expansion of a longitudinal fold demand early correction.

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Korotkevich A.G., Leont’yev A.S., Yaroshchuk S.A., Bondarev O.I., Aksenov P.V. ENDOSCOPIC PAPILLOSPHINCTEROTOMY IN ACUTE BILIARY PANCREATITIS AS PREVENTION AND TREATMENT POSTCHOLECYSTECTOMICAL SYNDROME. Experimental and Clinical Gastroenterology Journal. 2016;126(04):30-36
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1. The Federal State Budgetary Scientific Institution “Petrovsky National Research Center of Surgery” (Moscow, Russian Federation)

Keywords:esophageal cyst,endoscopic ultrasonography,EUS

Abstract:The aim of the study is to present an endoscopic ultrasound variety of esophageal cysts as a cause of diagnostic difficulties. Between 2005 and 2015 endoscopic ultrasonography (EUS) was performed in 31 patients with fluid intramural lesion of esophagus (22), stomach (5) and duodenum (4). It was found that intramural cysts can be located in any layers of the esophageal wall. Furthermore they can have the unusual echo-structure, which can lead to wrong conclusions. EUS should be included in the modern algorithm of examination of patients with so-called upper submucosal lesions. FNA may be performed if necessary.

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Bulganina N.A., Godzhello E.A., Khrustaleva M.V. ENDOSCOPIC ULTRASONOGRAPHY IN DIAGNOSIS OF INTRAMURAL ESOPHAGEAL CYSTS. Experimental and Clinical Gastroenterology Journal. 2016;128(04):37-42
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1. City Clinical Hospital # 1” (Moscow, Russian Federation)
2. Endocrinology Research Center (Moscow, Russian Federation)
3. Moscow Regional Research and Clinical Institute(Moscow, Russian Federation)
4. Medical center “Mozhayka 10”(Moscow, Russian Federation)
5. Pirogov Russian National Research Medical University (Moscow, Russian Federation)

Keywords:contrast-enhanced endoscopic ultrasound,insulinoma,proinsulin,immunohistochemistry,enucleation,EUS

Abstract:Since October 2015 we have started to use contrast-enhanced endoscopic ultrasound (CE EUS) in some patients, among them there were two patients with insulinomas. One patient with unknown origin hypoglycemia was interesting from the diagnostic viewpoint. The laboratory diagnostic problems were related to the fact that the tumor almost did not produce insulin. Just detecting hyperproinsulinaemia we managed to prove the endogenous hyperinsulinism. At topical diagnosis CE EUS was the only one method detected hyper-vascularized tumor in pancreatic isthmus. The tumor was successfully enucleated laparoscopically. Immunohistochemical study confirmed neuroendocrine tumor with predominant production of proinsulin. Normoglycemia was defined at two-month follow-up

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Full text is published :
Silina T.L., Molashenko N.V., Dalgatov K.D., Raksha A.P. et al. THE FIRST EXPERIENCE OF CONTRAST ENHANCED ENDOSONOGRAPHY IN CONTROVERSIAL DIAGNOSIS CASE OF PANCREATIC INSULINOMA. Experimental and Clinical Gastroenterology Journal. 2016;128(04):43-46
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1. Orenburg State medical University(Orenburg, Russian Federation)
2. Orenburg regional clinical Oncology center (Orenburg, Russian Federation)

Keywords: INTESTINAL-COLONIC ANASTOMOSIS, SPHINCTER, gastrointestinal surgery

Abstract:The article is devoted to one of the main problems of gastrointestinal surgery - the pathology of the colon, such as malignant tumors, diverticulosis, Crohn's disease, traumatic injuries, large benign tumors, and some other diseases. All of them require resection of the right half of the colon and the restoration of intestinal continuity by creating an anastomosis between the small and large intestine. However, such operations still have a very large number of complications. The most dangerous complication is the failure of the sutures of the colonic anastomoses and peritonitis that develops as a result, which is the main cause of death of patients. The article gives EXPERIMENTAL SUBSTANTIATION AND describes the CLINICAL APPLICATION OF NEW MICROSURGICAL METHODS of INTESTINAL-COLONIC ANASTOMOSIS WITH SPHINCTER PROPERTIES.

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Full text is published :
Tretjakov A.A., Kagan I.I., Nikitenkov A.G., Dronova O.B. et al. EXPERIMENTAL SUBSTANTIATION AND CLINICAL APPLICATION OF NEW MICROSURGICAL METHODS INTESTINAL-COLONIC ANASTOMOSIS WITH SPHINCTER PROPERTIES. Experimental and Clinical Gastroenterology Journal. 2016;128(04):47-50
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1. State University of Medicine and Pharmacy „Nicolae Testemitanu“ of the Republic of Moldova (Kishinev, Republic of Moldova)
2. Labromed Laborator SRL company, Republic of Moldova (Kishinev, Republic of Moldova)

Keywords:lower esophageal sphincter,electrical stimulation,gastroesophageal reflux disease

Abstract:Study aims. Recently the possibility of LES tonus increasing by the means of implantable electrical stimulator was described. Although this method is already used in clinical practice, optimal parameters of LES electrical stimulation are still unknown. The goal of this study was obtaining of clinical data regarding effects of different modes of electrical stimulation on LES tonus. Methods. LES electrical stimulation using external pulse generator was assessed in 9 patients with severe GERD and decreased LES tonus. These patients underwent standard laparoscopic antireflux intervention with additional insertion of 2 temporary electrodes at the level of gastroesophageal junction. Three sets of parameters were studied: 1) low-frequency, long pulse (375 ms pulses, 5 mA at 6 pulse/min); 2) high-frequency stimulation (0.3 ms, 5 mA at 20 Hz); 3) high-frequency at 40 Hz (0.3 ms, 5 mA). High resolution esophageal manometry was used to assess changes in LES tonus. Results. Values of LES resting pressure and integrated relaxation pressure (IRP) were significantly different between prestimulation and poststimulation periods. The low-frequency, long pulse stimulation produces improvement of esophagogastric junction relaxation in the poststimulation period. Patients stimulated with the second and the third sets of parameters demonstrated moderate relaxation of LES during the stimulation period and considerable increase of sphincter tonus in the poststimulation period. Conclusions. Electrical stimulation of LES produces changes in its tonus. Modifications of LES function during the stimulation and after the stimulation period depend on frequency and pulse width. Further clinical studies are necessary for selection of optimal stimulation parameters, which can be applied in the treatment of GERD.

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Ungureanu S.N., Lepadatu K.I., Sipitco N.I., Vidiborschii V.L. et al. INFLUENCE OF ELECTRICAL STIMULATION ON FUNCTION OF THE LOWER ESOPHAGEAL SPHINCTER IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE. Experimental and Clinical Gastroenterology Journal. 2016;128(04):51-55
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1. Branch Clinical Hospital at the Vladivostok Station, OAO «RZhD» (Vladivostok, Russian Federation)
2. Pacific State Medical University (Vladivostok, Russian Federation)

Abstract:The aim of the study was to test effectiveness and safety of cold snare polypectomy in small colonic polyps ≤8 mm in size. Method. In all, 148 consecutive patients with 308 small colorectal polyps were treated with cold snare polypectomy (CSP). Results. The average polyp size was 5.2±1.8 mm. 93.6% of polyps have been retrieved. Lost polyps were smaller then retrieved ones 3.8±1.5 mm vs 5.3±1.7 mm (р=0,0002). R0 resection has been achieved in 88.9% of cases. Serrated morphology was the only risk factor for R1 resection (р=0,008). There was no perforation or delayed bleeding. Intraprocedural bleeding was rate was 1.6% Conclusion. The data show that the CSP technique is safe and effective for small polyp removal.

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Full text is published :
Agapov M.Yu., Khalin K.D., Barsukov A.S., Ryzhkov E.F., Zvereva L.V. THE EFFICACY AND SAFETY OF COLD SNARE POLYPECTOMY FOR COLON POLYPS SIZE ≤ 8 MM. Experimental and Clinical Gastroenterology Journal. 2016;128(04):56-60
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