[The efficacy of endoscopic endosonography in diagnosis of benign and malignant stenoses of common bile duct].

AIM: To define criteria and to estimate diagnostic significance of endosonography in differential diagnosis of benign and malignant stenoses of common bile duct. MATERIAL AND METHODS: We presented the results of survey and treatment of 57 patients with benign and malignant stenoses of common bile duct. The technique of endosonography is described. We have formulated major criteria of differential diagnostics of tumoral and non-tumoral lesion of extrahepatic bile ducts. Comparative analysis of endosonography, ultrasound, computed tomography and magnetic resonance cholangiopancreatography was performed. RESULTS: Sensitivity, specificity and accuracy of endosonography in diagnosis of stenosis cause is 97.7%, 100% and 98.2% respectively. So it exceeds the efficacy of other diagnostic X-ray methods. In modern surgical clinic endosonography should be mandatory performed. It is necessary for final diagnostics of cause of common bile duct stenosis especially in case of its low location.

[Endosonography in the T-staging of pancreatic cancer].

Pancreatic cancer is the sixth among all oncologic diseases and takes the 4th place on cancer mortality in the world. Pancreatic cancer has poor prognosis. Survival for the 5 years after diagnosis is less than 5%. The objective was the evaluation of endosonography diagnostic significance in identification of tumor vascular invasion and tumor resectability. The treatment results of 82 patients with pancreas adenocarcinoma, technique of endosonography, the types of echo-endoscopes and ultrasonic criteria of vascular invasion are presented in the article. Tumor invasion was suspected in 48 patients (58.5%) during endosonography. Tumor invasion into the blood vessels of the upper abdomen was observed in 51 patients (62.2%). Endosonography sensitivity for detection of tumor invasion was 90.2%, specificity - 93.5%, accuracy - 91.5%. In view of modern criteria of pancreatic cancer resectability endosonography is leading method for selection of patients for surgical treatment.

[Diagnostics and tactics of gastrointestinal stromal tumor surgical treatment].

45 patients with gastrointestinal stromal tumors (GIST) were under observation. In 30 cases the GIST came from the stomach, in 8 cases - from the duodenum, and in 7 cases - from the small intestine. In all cases the diagnosis was confirmed by immunohistochemical study. Specific clinical manifestations of GIST were absent. Ultrasound detected the tumors that were more than 30 mm in diameter. The most informative diagnostic technique was computerized tomography with a contrast. All patients were operated. 29 patients with a diameter of tumor more than 50 mm had traditional open operation. In case the tumor oversteped the limits of the capsule or capsule's damage during the operation, the extirpation of the gastrocolic omentum was done. If the GIST were less than 50 mm they were extracted with the robot-assisted or laparoscopic methods. The long-term results of the treatment (from 3 to 60 months) of 28 patients were analyzed. 3 patients died of disease progression, 1 patient had metastasis in liver and 24 patients hadn't the signs of relapse.

[The development of severe methemoglobinemia in patients receiving "Almagel A"].

This clinical case and the literature review show possible development of methemoglobinemia due to the use of local anesthetics, included in drugs for the gastrointestinal diseases treatment, in particular benzocaine, which is the methaemoglobin forming agent. These drugs are common and often taken by the patients themselves without any control. The aim of our paper is to draw the attention of physicians to the risk of the widely known drug administration which can be purchased without a prescription.

[Endoscopic trachea stenting for scar strictures as a preparation for the surgical treatment].

The article analyzes the results of the endoscopic tracheal stenting of 33 patients with cicatrical stenosis. The patients aged 19-72 years. All patients had the acquired stenosis after intubation and tracheostomy. In 12 cases the procedure was successful, no complications were observed. In 3 cases the endoscopic stentin was the final stage of the treatment. The temporary stenting was effective in 8 cases. Stent migration was observed in 2 patients. The stent exposition ranged 8-90 days.

[Robotic-assisted and laparoscopic hepatic resections for nonparasitic cysts of posterior liver segments].

Results of 36 robotic-assisted and laparoscopic hepatic resections for nonparasitic cysts of posterior liver segments were demonstrated. Technical aspects of the procedure, advantages and drawbacks of each method were discussed. Important intra- and postoperative indexes were compared. The study allows to state, that the use of the da Vinci robotic surgical system has certain technical advantages over the standard laparoscopic technique in case of the posterior location of liver cysts.

[Tactics of surgical treatment of chronic pancreatitis].

585 patients were operated on the reason of chronic pancreatitis. 246 patients received various drainig operations: cystojejunostomy with Roux-en-Y anastomosis (n=97), longitudinal pancreatojejunostomy (n=86), external draining of the absceding postnecrotic cysts (n=51), internal draining (n=12). Resections of the pancreas were performed in 327 cases: Frey operation (n=83), Beger operation (n=46), pancreatoduodenal resection (n=61) - of them 55 were suspicious to cancer and 6 had pancreatic dystrophy. Distal resection of the pancreas was performed in 6 cases. 33 patients were operated on pseudoaneurisms, of the 12 patients received endovascular operations. Posoperative complications were registerd in 119 (20.3%) patients. 7 (1.2%) patients died.

[Endoscopic diagnostics and treatment of submucous tumors of the upper gastrointestinal tract].

The endoscopic ultrasonography (EUS) is considered to be the leading method of diagnostic of the submucous gastrointestinal tumors. Results of diagnostics and treatment of submucous tumors of the upper gastrointestinal tract in 38 patients were analyzed. EUS was performed in 37 (97,4%) of patients, which allowed to detect the origin, size and localization of the tumor. The differential diagnostic algorithm was suggested together with certain indications for various surgical treatment modalities. Thereby, endoscopic ablation is reasonable when the tumor invades not deeper than muscle plate of mucosa or the submucose layer. Laparoscopic full-layer resection of the organ wall is necessary when the tumor invades the muscle layer. Larger tumors or those of any size, but with preoperative signs of high malignancy must be eradicated through laparotomy, meeting all principles of oncology.

[Endoscopic ultrasonography in the diagnosis of neuroendocrine tumors of the pancreas].

In this article presented results of examination and treatment of 30 patients with suspected neuroendocrine tumors (NEO) of the pancreas during the period from 2007 to 2010. In the 22 cases were identified solitary pancreatic tumor, and 4 observations--multiple. Functioning NEO were detected in 19 observations, dysfunctional--7. The main objective of endosonography was a differential diagnosis of NEO with adenocarcinoma and chronic pancreatitis, as well as the topical diagnosis of small tumors that are inaccessible by other imaging beam method. Among the 27 patients operated on NEO confirmed in 26. In 1 case was revealed adenocarcinoma. Endosonography in NEO-functioning method of diagnosis is a priority, having the highest sensitivity, specificity and accuracy among all modern radiological methods of diagnosis.

[Endosonographic diagnostics of hepatobiliary and pancreatic diseases].

Clinical use of endoscopic ultrasound (EUS) diagnostics of 550 patients with diseases of hepatobiliary and pancreas was analyzed. The procedure of the examination was thoroughly described. Ultrasound semiotics of the pancreas, papilla Vateri and bile ducts' lesions was defined. Accuracy of EUS in the diagnostics of solid pancreas tumors was 81,6%. Accuracy of the method in the diagnostics of the vessel invasion was 81,6%. EUS was considered to be leading in the diagnostics of papilla Vateri and duodenal tumors, its accuracy was up to 97,2%, which is much higher then other radiological and endoscopic methods. EUS was highly effective in diagnostics of choledocholithiasis and comprised 90,2%. The introduction of thin-needle biopsy, Doppler mapping and elastography in the EUS protocol permitted further increase of the accuracy and value of the method for the surgical practice.

[Endoscopic diagnostics and management of postoperative gastrointestinal bleedings].

The features of clinical course, the frequency and the pattern of gastrointestinal bleedings after diverse abdominal operations were studied over a period of time from 1993 to 2006. Postoperative gastrointestinal bleedings were observed at 503 patients. The frequency of postoperative gastrointestinal bleedings amounted 0.5% after operations on account of purulent diseases with different localization, 0.6% after abdominal and cardiovascular operations, 0.8% after lung operations, 1.5% after operations on the account of burn disease, 6.1% after hepatopancreatobiliary operations. In accordance with the stages of postoperative period, distinctions in endoscopic picture and the tactics of treatment early and late bleedings were distinguished during the investigation. It has been established, that blood supply disturbance in portal vein, manifested by transient portal hypertension is, one of the most important pathogenetic factors of development of bleeding after hepatopancreatobiliary operations along with acute erosive (ulcerous) affection, caused by stress or trauma, and multiple organ failure. The features of clinical course of postoperative bleedings were studied in different groups of surgical patients. The comparative evaluation of efficacy of endoscopic methods of hemostasis (injection,various endoclips, hydrothermocoagulation, argon-plasma coagulation) was carried out. It was shown that the application of new methods of endoscopic sanation and investigation of the upper gastrointestinal tract had resulted in increase of frequency of exposure of gastrointestinal bleeding source from 69.8% to 88.4% at primary urgent esophagogastroscopy. The efficacy of hemostasis at postoperative gastrointestinal bleeding raised from 70.3% to 92.4%.

[Endoscopic ultrasonography in diagnosis of surgical treatment of pancreas].

Results of endoscopic ultrasonography at 137 patients suspected for pancreas pathology are analyzed. Methodology of endoscopic ultrasonography, semiotics of pancreas surgical diseases, advantages over other diagnostic methods are described. Endosonography is informative method for final diagnosis of different disease of pancreas. Diagnostic value of method and area of its clinical application are described.

[Temporary endoscopic stenting of bile ducts].

Experience of endoscopic stenting for preoperative preparation of patients with various diseases of hepatopancreatobiliary zone and high surgical risk is analyzed. Internal drainage (stenting) of bile ducts was performed at 45 (58%) patients, external - at 24 (31.1%), combined external-internal - at 8 (10.4%) patients. Advantages and disadvantages of each stenting type are evaluated, differential indications are determined. Analysis of short-term results demonstrates that the rate of early postoperative complications is lower at patients operated after bile ducts stenting that at ones operated on jaundice peak. It is concluded that endoscopic stenting of bile ducts permits to increase efficacy of preoperative preparation for surgical or endoscopic procedures, and to decrease the risk of their complications.