Objective. To summarize current evidence on the principles of bowel preparation for colonoscopy. Key points. The quality of bowel cleansing is an independent quality indicator of colonoscopy and affects mucosal visualization, detection of colorectal neoplasia, and the need for repeat examination. Current international guidelines consider split-dose regimens preferable for elective colonoscopy, whereas a same-day morning regimen is mainly acceptable for procedures scheduled in the afternoon. The last dose of the bowel-cleansing agent should preferably be started within 5 hours before colonoscopy and completed at least 2 hours before the procedure. Selection of the bowel preparation should take into account age, chronic constipation, diabetes mellitus, chronic kidney disease, cardiovascular comorbidity, concomitant medications, and the risk of fluid and electrolyte disturbances. Iso-osmotic polyethylene glycol solutions with electrolytes, together with low-volume polyethylene glycol preparations containing ascorbate, remain important first-line options because of their established efficacy and predictable safety profile. The macrogol 4000 and electrolyte preparation Lavacol is registered both for bowel cleansing and for the symptomatic treatment of constipation, which may be of practical relevance in patients prone to constipation. Low-volume sulfate-based preparations provide effective bowel cleansing but require adequate additional hydration and should be used cautiously in older and comorbid patients because of the risk of fluid and electrolyte disturbances. Conclusion. Optimal bowel preparation for colonoscopy should be individualized and include assessment of risk factors, appropriate dietary modification, preferential use of a split-dose regimen, and selection of the preparation according to the patient’s clinical profile. Standardization of these measures may improve the rate of adequate bowel cleansing and the diagnostic yield of colonoscopy.
Objective. To evaluate the clinical utility of metallic stent placement in the management of pancreatic fluid collections. Case report. We report a case of endoscopic drainage of a pancreatic pseudocyst in a 51-year-old patient with complicated acute pancreatitis using a self-expandable metallic stent. The procedure time was 30 minutes. No intraoperative or postoperative complications occurred. Following stent placement, repeated endoscopic necrosectomy and irrigation of the cyst cavity were performed with removal of necrotic debris. Follow-up imaging demonstrated a reduction in the size of the cystic cavity from 14.1×9.0×9.0 cm to 5.1×3.2×2.1 cm, with complete resolution of necrotic debris. The cavity walls showed granulation tissue formation. The patient was discharged in satisfactory condition. Conclusions. Endoscopic ultrasound-guided cystogastrostomy with placement of a self-expandable metallic stent is a modern, effective, and minimally invasive treatment option that may serve as an alternative to conventional surgical management. Further studies are required to evaluate the efficacy of this technique and its long-term outcomes.
Introduction. Colorectal cancer (CRC) ranks second worldwide in prevalence and mortality among all malignancies. The implementation of screening programs based on fecal immunochemical testing (FIT) followed by colonoscopy is an effective strategy for reducing morbidity and mortality. In the Russian Federation, CRC screening is integrated into the clinical health examination of certain adult population groups. Aim. To assess the dynamics of colorectal cancer incidence and mortality in the Leningrad Region for the period 2015—2024, as well as the effectiveness of screening programs based on fecal immunochemical testing (FIT) and colonoscopy in the region for 2022—2025. Material and methods. A retrospective epidemiological analysis of official statistics data for the Leningradskaya Region, the Northwestern Federal District, and the Russian Federation was performed. Data from the annual reports «Malignant Neoplasms in Russia» edited by A.D. Kaprin and data from the Health Committee of the Leningrad Region for 2015—2025 were used. Incidence, mortality, stage distribution, FIT-testing coverage, number of colonoscopies, and active detection of CRC were analyzed. Results. During 2015—2024, a decrease in the incidence of colon cancer (average annual rate 24.11 vs 29.51 in Russia) and rectal cancer, rectosigmoid junction, and anal cancer (16.09 vs 20.9 in Russia) was observed in the Leningrad Region. CRC mortality decreased by 19.3% (colon cancer) and by 28% (rectal cancer). The proportion of stages III—IV decreased from 55% to 49%, while stage I detection increased from 6% to 17%. FIT-testing coverage increased from 12.6% to 30.0%, and the proportion of colonoscopies following positive FIT reached 70.0%. In 2025, 3.384 adenomatous polyps were detected. Active CRC detection in 2024 was 27%. Conclusion. CRC screening programs in the Leningrad Region have demonstrated effectiveness: increased detection of CRC and precancerous lesions is accompanied by improved stage distribution and reduced mortality. However, the active detection rate (27%) remains significantly below the target level (85%), indicating the need for further improvement in screening organization.
Objective. To present current evidence on Allgrove syndrome and to review diagnostic and therapeutic approaches to achalasia associated with this condition based on a clinical case. Key points. Allgrove syndrome (Triple-A syndrome) is a rare autosomal recessive genetic disorder characterized by a triad of features: chronic adrenal insufficiency, achalasia, and alacrima. The condition is caused by mutations in the AAAS gene located on chromosome 12q13. The clinical presentation of achalasia in Allgrove syndrome is generally comparable to that of idiopathic achalasia; however, the disease typically manifests in childhood, which determines specific clinical features, including less pronounced dysphagia, growth retardation, and a predisposition to recurrent respiratory infections. The diagnostic workup for suspected achalasia includes barium esophagography, esophagogastroduodenoscopy, and esophageal manometry. High-resolution manometry is considered the gold standard for diagnosis, including in pediatric patients, as it allows accurate classification of achalasia subtypes and facilitates optimal selection of surgical strategy. Historically, laparoscopic Heller myotomy has been the mainstay of treatment for achalasia. In 2010, Inoue introduced an alternative minimally invasive technique—peroral endoscopic myotomy (POEM), which is performed via an intraluminal approach to the esophageal muscular layer. To date, substantial experience with POEM has been accumulated in adult populations, whereas its use in pediatric patients remains limited. Conclusion. Diagnostic strategies and determination of the extent of myotomy in patients with Allgrove syndrome should be guided by high-resolution manometry findings and aligned with the principles applied in the management of idiopathic achalasia.
Objective. To assess the prevalence and spectrum of extraintestinal manifestations (EIMs) in patients with ulcerative colitis (UC) and Crohn’s disease (CD) followed at the North-Western Centre for the Treatment of Inflammatory Bowel Disease (IBD) of the North-Western State Medical University named after I.I. Mechnikov. Material and methods. This single-centre, cross-sectional observational study included 258 patients with an established diagnosis of IBD: 118 patients with UC and 140 patients with CD. Participants were enrolled between 2023 and 2026. Data on EIMs were obtained from medical records, the centre’s patient registry, and reports provided by relevant medical specialists. The Mann—Whitney U test, Pearson’s χ² test, and Fisher’s exact test were used for between-group comparisons. Results. EIMs were documented in 111 of 258 patients, corresponding to a prevalence of 43.0% (95% [CI], 36.9—49.3). The most common manifestations were arthropathies, reported in 80 patients, and aphthous stomatitis, reported in 29 patients. Erythema nodosum, ankylosing spondylitis, iridocyclitis, pyoderma gangrenosum, and primary sclerosing cholangitis were substantially less frequent. Patients with CD were younger than those with UC: the median age was 35.0 [30.0; 44.2] years and 41.5 [30.0; 54.0] years, respectively (p=0.036). EIMs were identified in 47.9% of patients with CD and 37.3% of patients with UC; however, the difference was not statistically significant (p=0.114). Conclusion. EIMs were documented in more than 40% of patients with IBD, with articular and oral mucosal involvement being the most common. These findings highlight the importance of targeted screening for EIMs and multidisciplinary management of patients with IBD.
