PERORAL ENDOSCOPIC MYOTOMY IN ESOPHAGEAL ACHALASIA: INTRAOPERATIVE COMPLICATIONS AND METHODS OF THEIR CORRECTION.

The authors analyzed complications in peroral endoscopic myotomy in case of esophageal achalasia in 27 patients. There were noted hypercapnia, carboxyperitoneum, hemorrhage, perforation of mucous coat of esophagus. These complications were suppressed during endoscopic manipulations.

[Modern methods of low-invasive treatment of the stricture and damage of the pancreatic duct, pancreatolithiasis].

The authors analyzed the experience of diagnostics and treatment of 49 patients. It was shown, that low-invasive methods of treatment (the endoscopic lithoextraction, stenting, surgical drainage) should be the priority means in treatment of pancreatolithiasis, strictures and cases of the pancreatic duct damage. The lethality consisted of 2.04% in these interventions.

[The possibilities of combined methods of minimally invasive interventions in treatment of benign diseases and lesions of the bile ducts].

The authors have shown the possibilities of minimally invasive operations under ultrasonic, endoscopic and radiological control in treatment of patients with lesions and strictures of the bile ducts. The experience is based on an analysis of operations on 68 patients. In most patients the patency of ducts was restored without using open traditional operations due to the developed and used combined minimally invasive operations.

[Choledocholithiasis in nonstandard situations: possibilities of combined methods of minimally invasive intervention].

The possibilities of minimally invasive combined interventions were shown in treatment of 49 patients with choledocholithiasis in nonstandard situations. The worked out and used minimally invasive combined operations allow ablation of concrements from bile ducts in patients who had undergone such operations as Billroth-II gastric resection and extirpation of the stomach and when cannulation of the major duodenal papilla is not possible. The authors have extended the possible application of minimally invasive methods of lithoextraction in patients with choledocholithiasis in nonstandard situations.

[Postnecrotic cysts of the pancreas: possible ways of minimally invasive external and internal drainage].

The authors have shown a possibility of minimally invasive interventional surgery in treatment of postnecrotic cysts of the pancreas and their complications. The most optimal accesses for drainage of the cavities located inside the body and the pancreas head are determined. The use of the methods of internal drainage of the cyst cavity connected with the main pancreatic duct allowed avoidance of open operations. The results of antegrade percutaneous or transcavital as well as retrograde endoscopic restoration of the patency of the main pancreatic duct in treatment of the pancreatic cysts connected with the duct system are shown.

[Acute gastroduodenal bleedings against the background of diabetes mellitus].

The authors have analyzed results of treatment of 60 patients with acute gastroduodenal bleedings against the background of diabetes mellitus. The main methods of diagnosis are the endoscopic and laboratory methods. In 60% of the patients the source of bleeding was acute erosion-ulcerous lesions, in 40% -chronic ulcers. Choice of the method of treatment depended on the source of bleeding, the degree of carbohydrate metabolism, the spectrum of concomitant pathology. Endoscopic hemostasis is the method of choice in treatment of acute and chronic ulcers of high risk of relapses in somatically burdend patients.

[Minimally invasive surgery of abscesses of the retroperitoneal space].

The article presents an experience with treatment of abscesses of the retroperitoneal space in 28 patients using interventions under ultrasonic control. All the patients underwent draining operations. Determination was made of optimal terms of operative treatment under the ultrasonic control depending on the character of pathological fluid accumulation; of rational approaches to the abscess cavity to support the safest passing the needle through the retroperitoneal space tissues. An algorithm of management of the patients at the stages of both stationary and ambulatory treatment was developed. An analysis of causes of the approach conversion after minimally invasive draining operations was made. Draining operations under USI control in most cases of retroperitoneal abscesses allowed sanitation of purulent cavities without open operations.

[Endoscopy in diagnosis and treatment of complicated esophageal anastomoses].

The authors describe an experience with treatment of 115 patients with complicated course after esophagogastroanastomoses and esophagojejunoanastomoses using endoscopic techniques. The diagnostic manipulations and algorithm of treatment of patients with early and late complications in the area of nutritional anastomoses were developed. Thanks to high tech minimally invasive interventions (bougienage, balloon dilatation, stenting, endoscopic hemostasis, dissection of scar strictures) traumatic reoperations could be avoided.

[Endoprosthesis of self-expanding metallic stents in stenosing diseases of the esophagus].

The article deals with the questions of treatment of diseases developing with constriction of the esophagus lumen using modern minimally invasive techniques. The authors set the tasks to improve treatment of patients with dysphagia using endoscopic stenting. Original solutions of complex problems are presented arising in treatment of such group of patients. A detailed analysis of complications is given and the scheme of the causes of their appearance which is thought to be actual.

[Peptic stenosing esophagitis].

The authors have performed examination and treatment of 55 patients with peptic stricture of the esophagus. The algorithm of examination (X-ray method, endoscopic method, express pH-metry of the upper part of the gastrointestinal tract, USI of the abdominal cavity organs) allowed characterization of the stricture, detection of the disease which resulted in its development. The treatment included endoscopic methods (bougienage, balloon dilatation) for restoration of patency of the esophagus, pharmacotherapy directed to suppression of gastric secretion and improving the motor function of the gastrointestinal tract. Frequent relapses of peptic strictures, suspected neoplasias in the patient's esophagus should be treated surgically.

[Potential of endoscopic hemostasis in patients with gastroduodenal bleedings].

The authors have analyzed their experiences with treatment of 61 patients using the method of endoscopic clipping: 24 of them had the source of bleeding in chronic ulcers of the duodenal bulb, 6 had chronic gastric ulcers, 15 had acute gastric ulcers, 2 had acute ulcers of the duodenal bulb, Mallory-Weiss syndrome was found in 2 patients, Dieulafoy syndrome in 10 patients and one patient had peptic ulcer of the gastro-entero-anastomosis. The endoscopic clipping was made in 11 patients, in 31 patients injections of adrenaline and coagulation were added, in 9 patients--coagulation only, in 2 patients--irrigation with caproferon, in 8--adrenaline injections. In 57 out of 61 patients reliable hemostasis was achieved.

[Treatment of patients with combined burn strictures of the esophagus and stomach].

The authors made an analysis of their experiences with treatment of 52 patients. The algorithm of examinations and treatment depending on the character of the injury of the esophagus and stomach is described. Positive results were obtained in 90% of the patients.

[The treatment of combined burn lesions of the esophagus and stomach]. / Lechenie sochetannykh porazhenii pishchevoda i zheludka.

In patients with an associated burn injury of the esophagus and the stomach, of determining significance is stenosis of the latter. Resection of the stomach is indicated in cases of subcompensated stenosis of the stomach with distinct boundaries of the scary damage. In parallel with the operation on the stomach for its stenosis, the formation of a gastrostoma of the proximal part of the organ should be also planned for the following bougienage of the esophagus by the directing thread.

[Present-day fiber endoscopy in the diagnosis and therapeutic tactics in foreign bodies of the upper digestive tract]. / Sovremennaia fibroéndoskopiia v diagnostike i lechebnoi taktike pri inorodnykh telakh verkhnikh otdelov pishchevaritel'nogo trakta.

Characterization of foreign bodies and their localization in the digestive tract in 404 patients is given. Surgical methods of treatment of such patients are described. Endoscopy was used for examination and treatment. The adequate anesthesia is thought by the authors to be necessary for a successful endoscopic removal of the foreign bodies. The indications for general anesthesia are enumerated. The endoscopic removal of the foreign bodies during surgical interventions are indicated in patients with the perforation of the esophagus by a foreign body.

[The treatment of stable esophageal cicatricial strictures]. / Lechenie stoikikh rubtsovykh striktur pishchevoda.

The roentgenological, endoscopic and combined methods of examination of patients allowed to make a program of treatment of patients by the method of bougienage. Different techniques of bougienage were used: "blind", by the direct thread, under the endoscopic control, endoscopic dissection supplemented by bougienage. A stable clinical effect was obtained in the overwhelming majority of patients.

[Endoscopy in the diagnosis and treatment of gastroduodenal hemorrhage]. / Endoskopiiia v diagnostike i lechenii gastroduodenal'nykh krovotechenii.

An experience of work of the department of general surgery with the course of endoscopy is presented. The endoscopic diagnosis and treatment of 2931 patients for 6 years were performed for bleedings from the upper parts of the gastrointestinal tract. Errors in endoscopic diagnosis made 5%. The authors divided them into three groups: methodical (preparing the patients, methods of examination), diagnostic (assessment of the substrate and type of bleeding, probability of recurrences), tactical (medical policy, dynamics of observations). Hemostasis in endoscopic arrest may be complete or temporary (stable or unstable). The most effective methods are thought to be coagulation, clipping and a combination of the methods. Medicamentous means are less effective. The authors recommend to be aware of the endoscopic possibilities and not to try to stop bleeding by any means thereby wasting time.