The guidelines describe modern approaches to equipping and ensuring endoscopic examinations of the digestive and respiratory systems in accordance with the objectives of improving their quality, safety and efficiency. The focus is on improving endoscopic diagnostics of precancerous diseases and early cancer of the gastrointestinal tract and bronchi. Based on the analysis of evidence-based medicine data, modern conditions for equipping and ensuring endoscopic examinations from the minimum necessary to the expert level are provided, including conditions for integrating digital solutions into protocols and reports, including conditions for creating databases for artificial intelligence systems, as well as conditions for ensuring epidemiological safety in endoscopy. The guidelines are based on risk-oriented approaches and serve as a basis for an objective assessment and analysis of the risks of compliance of equipment and provision in endoscopy with modern requirements for the quality and safety of medical activities. The components of equipment and provision are presented in summary tables, which in practice can serve as checklists. Each component is also an evaluation parameter and can be assessed by qualitative (present or absent) and/or quantitative (% provision) indicators. The methodological recommendations are designed in accordance with the requirements of the current GOST R 6.30-2003: “Unified documentation systems. Unified system of organizational and administrative documentation. Requirements for the execution of documents” (updated on 05/25/2017), which states that this type of methodological product, based on positive experience, reveals the order and logic of setting up any methodology. The objectives of such documents include the promotion of the most effective and rational examples of practical actions applicable to a certain type of activity, according to which the terminology, style and volume of methodological recommendations are regulated.

Juvenile polyposis syndrome (JPS), a rare disease with an autosomal dominant mode of inheritance, which is characterized with the presence of multiple polyps in various parts of the gastrointestinal tract, mainly in the colon. The detection of adenomatous polyps in patients with JPS, in addition to juvenile ones, significantly complicates the differential diagnosis with familial adenomatous polyposis, in which it is necessary to perform a radical surgery — proctocolectomy. Only in 40-60% of cases, pathogenic variants of the SMAD4 and BMPR1A genes can be identified, each of which is characterized with its own clinical manifestations. Treatment options for patients with JPS include endoscopic and surgical; however, the decision-making algorithm, as well as the timing of postoperative follow-up, are not evaluated in Russian clinical guidelines. The rare occurrence of this syndrome, difficulties in endoscopic diagnosis and morphological verification, as well as limitations in determining the molecular genetics cause of the disease demonstrate the need for further research.

AIM: to develop ultrasound semiotics of solitary rectal ulcer (SRU).PATIENTS AND METHODS: fifty-eight patients with a histologically verified SRU were included in the retrospective study. All patients underwent colonoscopy and transrectal ultrasound (TRUS). Changes in rectal wall detected by TRUS were compared with colonoscopy data.RESULTS: On TRUS SRU is represented by a significantly thickened rectal wall (median thickness of the rectal wall in the region of SRU is 9 (7–10) mm and 5 (4–6) mm outside, p < 0.001), most often with a predominance of muscular and submucosal layers (46/58, 79%). The structure and echogenicity of these layers are changed: the connective tissue layer is visualized in muscular layer (51/58, 88%), submucosal layer is hypoechogenic (47/58, 81%), boundaries between rectal wall layers are faded (50/58, 86%). Ulcers in SRU are characterized by presence of areas where the mucous layer cannot be traced (sensitivity 100%, specificity 95%), its extent is comparable to extent of ulcers detected on colonoscopy (p = 0.528). Polypoid SRU is characterized by local thickening of the mucosa (sensitivity 89%, specificity 95%). TRUS location of the SRU in height (p = 0.644) is comparable with colonoscopy data.CONCLUSION: the study determined general ultrasound signs of SRU and made it possible to differentiate macroscopic forms of SRU from each other with TRUS.

OBJECTIVE: to compare the immediate and long-term results of endoscopic mucosal resection with a circular incision (C-EMR) and endoscopic submucosal dissection (ESD) in the treatment of patients with large benign epithelial neoplasms of the colon.PATIENTS AND METHODS: a prospective randomized comparative study was conducted from November 2020 to July 2022, included 103 patients with benign epithelial neoplasms of the colon ranging in size from 20 to 30 mm. The C-EMR method was used in 52, ESD - 51 patients.RESULTS: the removal of the tumor by the C-EMR method required statistically significantly less time, compared with the ESD method – 30 and 60 minutes, respectively (p<0.001). Intra- and postoperative complications occurred in 13(23.7%) patients in the C-EMR group and in 12(23.5%) patients in the ESD group. The most frequently reported complication was postcoagulation syndrome in the main and control groups – in 9(17.3%) and 11(21.6%) cases, respectively. It was found that the difficult location of the tumor (OR=18.3; p=0.01) and intraoperative complications (OR =37.5; p=0.04) are independent conversion factors of endoscopic intervention. The frequency of tumor removal in a en bloc and achievement of negative resection margins (R0) in the main and control groups did not significantly differ – 47(90.4%) and 49(96.1%) (p=0.4) and 40(76.9%) and 45(88.2%) (p=0.2), respectively.CONCLUSION: endoscopic mucosal resection with a circumferential incision is an effective and safe operation comparable to endoscopic submucosal dissection, and can be the method of choice for benign epithelial neoplasms of the colon with sizes from 20 to 30 mm. In addition, the duration of the operation using the C-EMR method is two times less than using ESD.

Aim: to evaluate diagnostic value of magnetic resonance enterocolonography (MR-enterocolonography) with the use of the segmental index MaRIAs (Simplified Magnetic Resonance Index of Activity) for inflammation activity in small and large intestine colon compared with ileocolonoscopy.Patients and Methods: the prospective cohort study included 58 patients with Crohn’s disease aged 19–45 years. All patients underwent MR-enterocolonography with intravenous contrast and ileocolonoscopy. MR-enterocolonography assessed inflammatory activity in the large and small intestine (406 segments) using the MaRIAs index (segmental). MRI data were compared with ileocolonoscopy.Results: ileocolonoscopy showed no signs of inflammatory activity in 71 (71/406, 17.5%) segments. In 168 (168/406, 41.3%) segments endoscopic signs of low or moderate inflammatory activity were detected, in 167 (167/406, 41.2%) segments inflammatory activity with the presence of ulcers were detected. MR-enterocolonography did not detect any activity in 121 (121/406, 29.8%) segments (0 points by MaRIAs index), in 285 (285/406, 70.2%) segments, the inflammation activity was revealed by MaRIAs index from 1 to 5 points. There was a moderate agreement (Cohen’s Kappa: 0.57) between the data of MR-enterocolonography and ileocolonoscopy in detection of affected segments. ROC analysis revealed that with the value of the MaRIAs index (segmental) of 1 point or more with sensitivity of 82.0% and specificity of 92.0% (AUC 0.85), it is possible to consider the presence of inflammatory activity of any severity, and with index value of 2 points or more with sensitivity of 75.0% and specificity of 91.0% (AUC 0.91) can diagnose the severe inflammation with ulcers.Conclusion: the results obtained revealed the value of MaRIAs index and the further study to evaluate the effectiveness of conservative treatment of Crohn’s disease is needed.

AIM: to establish the consensus on controversial issues of the surgery for Сrohn’s disease by Delphi method. METHODS: a cross-sectional study was conducted by the Delphi method. 62 experts voted intramural and anonymous (31.03.23). 5 statements from the current edition of clinical guidelines were selected for correction by working group and further voting [2]. Based on the practical experience of the working group and literature data, 3 new statements were created also. Statements that do not reach the required level of agreement (80% or more) will be subjected to Round 2 of the Delphi method. RESULTS: all experts took part in the anonymous voting. The panel of experts is represented by 8 different areas of practical medicine and the median of the professional experience of the respondents was 30 (12–49) years. Of the 8 statements submitted for voting, consensus (80% or more) was reached on 6 out of 8. 2 statements have been revised by working group for the distance 2nd round of the Delphi study. Consensus (more than 80%) was reached on both. CONCLUSION: a cross-sectional study by the Delphi method provided the opinions of a panel of experts on controversial issues in the surgical treatment of Crohn’s disease. Statements that reach consensus will be included by the working group in a new edition of clinical guidelines of Crohn’s disease.

Universita degli Studi di Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Istituto Europeo di Oncologia, Italy; Centro di Riferimento Oncologico IRCCS, Italy; Fondazione Poliambulanza Istituto Ospedaliero, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy; Universita Cattolica del Sacro Cuore, Italy; Ente Ospedaliero Valduce, Italy; Aziende Socio Sanitaria Territoriale Rhodense, Italy; NTC, Italy; Hopital Edouard Herriot, France; Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Italy; Ospedale Santa Chiara di Trento, Italy; Yaroslav Regional Cancer Center, Russian Federation; IRCCS Sacro Cuore Don Calabria, Italy; Ospedale Papa Giovanni XXIII, Italy; Universita degli Studi di Brescia, Italy; Irkutskij gosudarstvennyj universitet, Russian Federation; Centre Hospitalier Regional Universitaire de Montpellier, France; State Scientific Center of Coloproctology named after A.N.

Introduction . Video capsule endoscopy (VSE) is a gold standard diagnostic method for small bowel diseases and is widely used in clinical practice. The presented analysis of the VCE results demonstrates the possibilities of this diagnostic tool and is the largest one of the analysis that were recently published in Russia. Aim . To demonstrate the possibilities of video capsule endoscopy in the diagnosis of small bowel diseases. Materials and methods . A total of 300 video capsule endoscopies were performed in patients with suspected and already established small bowel diseases between 2014 and 2022. All patients who underwent a video capsule endoscopy in the settings of the National Medical Research Center of Coloproctology named after A.N. Ryzhikh were over 18 years old. The study cohort included 158 men and 142 women. The average age of patients at the time of the video capsule endoscopy was 42 ± 15.4 years. The patients were recommended a standard preparation regimen: 3 days before the study, a protein diet was prescribed, and the day before, a two-stage administration of a PEGbased drug (“split dose”). To reduce gas production and decrease the amount of foamy intestinal contents, which worsens the quality of the endoscopic image, oral administration of an antifoam agent simethicone was prescribed: 80 mg on the eve of the endoscopy and 80 mg on the day of the endoscopy. Results . The video capsule endoscopy demonstrated high information value in the diagnosis of inflammatory bowel diseases: its sensitivity was 86%, and specificity – 90%. Similar results were obtained during video capsule endoscopy used to diagnose the source of possible bleeding: sensitivity and specificity were 87 and 68%, respectively. Conclusion . Video capsule endoscopy is an effective, safe and well-tolerated tool for diagnosing small bowel diseases. The video capsule endoscopy findings contribute to establishing a correct diagnosis and selecting treatment strategies.

AIM: to assess results of balloon dilatation (BD) and electric destruction (ED) for strictures of colorectal anastomoses. PATIENTS AND METHODS: the prospective cohort study included 69 patients with colorectal anastomotic strictures. Thirty-two of them underwent endoscopic balloon dilatation, 37 — electric destruction of scar tissue using a spherical monopolar electrode. RESULTS: the recurrence rate of the anastomotic stricture in the BD group was 3 times higher than after ED (OR = 2.9; 95% CI: 0.7–11.1; p = 0.04). The independent factor of stricture recurrence was the extent of stricture > 11 mm (OR = 11.8; 95% CI: 1,57–123,5; p = 0.02). CONCLUSION: electric destruction and balloon dilatation are effective and safe methods for strictures of colorectal anastomoses. The independent factor recurrence risk of the stricture was the extent of the scar narrowing more than 11 mm long.

Aim: to evaluate the early results of endoscopic submucosal tunnel dissection (ESTD for large benign colon neo-plasms. Patients and methods: a prospective non-randomized comparative study included 100 patients with large benignepithelial colon neoplasms (more than 3 cm in diameter). The main group included 50 patients who underwentendoscopic submucosal tunnel dissection. The control group included 50 patients who underwent traditional endo-scopic submucosal dissection (ESD). Results: Four (4 %) patients (1 in the main and 3 in the control group) were excluded from the study due to theconversion of endoscopic procedure. The incidence en bloc removal of neoplasms and the negative resection margins were significantly higher in the main group than in the control one — 98 % and 87.2 % (p = 0.04) and 89.8 % and 70.2 %, respectively (p = 0.01). Conclusion: ESTD for large benign epithelial colon neoplasms shows better radicalness in comparison with endo-scopic submucosal dissection.

The aim of the study: to estimate the efficacy of the colorectal cancer (CRC) risk assessment according to the questionnaire and the fecal immunochemical test (FIT). The pilot study included 2,324 respondents over 40 years of age, without severe comorbidities, who filled out the original questionnaire and had the FIT. Risk stratification (high, moderate, low) was done using the original software for automatic data processing. Occult blood detection in feces was done using the fecal immunochemical test. Colonoscopy was proposed for all persons included in the screening program. The questionnaire revealed the high CRC risk in 272 (11.7 %) respondents, moderate risk — in 1,349 (58.0 %), and low risk — in 703 (30.0 %) respondents. The respondents with the high CRC risk had positive FIT results significantly more often — 199 (73.2 %) respondents, with 148 (11.0 %) respondents in the moderate-risk group, and 21 (3.0 %) respondents in the low-risk group (р<0.0001). Colonoscopy was performed in 28 (10.3 %) persons in the high-risk group, 76 (5.6 %) — in the moderate-risk group and in 50 (7.1 %) respondents in the low-risk group. The clinically important colon diseases (CRC, colorectal polyps, and IBD) were revealed significantly more often in the high-risk group than in moderate- and low-risk groups (82.1 % vs 68.0 %; p=0.02) and in those with positive FIT (87.5 % vs 60.5 %; p=0.01). Conclusion: the preliminary results showed that risk stratification by questionnaire is not inferior in the detection of clinically significant diseases of the colon than the fecal immunochemical test. It is necessary to continue the screening project with increasing the proportion of colonoscopies in all risk groups to obtain valid results.

AIM: to determine the diagnostic efficiency of magnetic resonance enterocolonography using inflammation indices (CDMI, MEGS) in assessing activity of the inflammatory process in the colon and small intestine in Crohn's disease.PATIENTS AND METHODS: the study included 42 patients with Crohn's disease (age ranged from 19 to 47 years). All patients underwent magnetic resonance enterocolonography (MRE) with intravenous contrast and diffusion-weighted images. According to the results of MRE, were determined MR indices of inflammation activity in the small and large intestine - CDMI and MEGS. The MR inflammatory activity indices CDMI and MEGS were compared with the endoscopic inflammatory activity index SES-CD.RESULTS: the MR inflammation activity index CDMI did not show a statistically significant diagnostic efficiency (p>0.05). The MR inflammation activity index MEGS showed a statistically significant diagnostic efficiency (p<0.0001). According to the nomogram, the MR inflammation activity index MEGS demonstrated a high predictive ability to determine the true activity of the inflammatory process in the small and large intestine. Correlation demonstrated direct strong relationship between the quantitative values of the MEGS inflammation indices and the endoscopic inflammation index (SES-CD) (r=0.843, p<0.0001).CONCLUSION: magnetic resonance enterocolonography using the MEGS activity index has a high diagnostic efficiency in assessing the activity of the inflammatory process in the small and large intestine in Crohn's disease. The MR inflammation activity index CDMI did not show statistically significant diagnostic efficacy. The results of the study should be considered preliminary and require further study of the possibilities of these indices of inflammation activity in a larger sample of patients.

AIM: to assess the early results in patients with benign epithelial colorectal neoplasms which underwent endoscopic mucosal resection with a circumferential incision (C-EMR). PATIENTS AND METHODS: a prospective randomized trial included 50 patients who underwent endoscopic removal of benign epithelial colorectal neoplasms sized 20–30 mm (November 2020 — January 2022). The main group included 26 patients which underwent C-EMR. The control group included 24 patients which underwent endoscopic submucosal dissection (ESD). RESULTS: postoperative complications developed in the C-EMR group in 5 (19.2%), and in the ESD group — in 7 (29.2%) cases (p = 0.51). The operative time in the C-EMR group was significantly less than in the ESD group — 30 vs 60 min., respectively (p < 0.001). In all cases in both groups, tumors were removed en bloc. There R0 resection were performed in 22 (84.6%) and in 23 (95.8%) cases in the main and control groups, respectively (p = 0.3). Two (8.3%) procedures in the control group were converted to the C-EMR procedure. CONCLUSION: endoscopic mucosal resection with a circumferential incision is an effective and safe method for removing benign epithelial neoplasms sized 20–30 mm, as well as submucosal dissection. The removal of the tumor by the C-EMR method reduces operative time by half compared with ESD method.

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants.

The objective of the study: to compare changes in the blood level of C-reactive protein (CRP) during the administration of different formulations of tocilizumab (TCZ) in COVID-19 patients admitted to hospital in real clinical practice.Subjects and methods. The cohort of 14 patients was included in the retrospective study; they all had a severe course of COVID-19 and were admitted to hospital: 7 patients received had intravenous infusions of tocilizumab and 7 had subcutaneous injections. The indication for tocilizumab prescription was the elevation of CRP blood level by 5 times and more or 2-fold and more elevation of ferritin above the norm. In the group receiving subcutaneous injections with tocilizumab, the proportion of elderly people was bigger and CRP levels were higher versus the group receiving intravenous infusions. The efficacy was assessed by changes in CRP levels on the 1st, 3rd and 7th day after the administration. The study included only the patients discharged from hospital with improvement of their state.Results. It has been demonstrated that when the patients develop cytokine storm, the use of both formulations of tocilizumab (for intravenous and subcutaneous administration) is effective. When tocilizumab was administered intravenously, the changes in CRP levels (especially at high rates - more than 150 mg/l) were more intense versus subcutaneous administration. The use of these formulations of tocilizumab had the same long-term efficacy: the level of CRP by the 7th day after administration decreased comparably in both groups, the time of complete normalization of this rate did not differ significantly. The different dynamics of CRP level decrease in each specific case could be associated both with the formulation of the drug and other factors that could not be established.

Aim: to identify risk factors for neoplasms recurrence removed by endoscopic mucosal resection (EMR).Patients and methods: the single-center retrospective observational study included 207 patients with 260 benign colon neoplasms. There were 95 (45.9%) males and 112 (54.1%) females. The median age of the patients was 67 (27-80) years. The results obtained were assessed using following criteria: morbidity rate, complication type, hospital stay, tumor site, number of neoplasms in colon, lateral growth, fragmentation rate, technical difficulties (mucosal fold convergence)during surgery, grade of dysplasia, recurrence rate.Results: intraoperative fragmentation of the neoplasms during mucosectomy occurred in 48/260 (18.5%) cases. Postoperative complications within the period of up to 30 days occurred in 13/207 (6.3%) patients. The most frequent 9 (4.2%) postoperative complication arising after mucosectomy was post-polypectomy syndrome. Another 4 (2.0%) patients produced bleeding after the surgery, which required repeated endoscopic procedure. No mortality occurred. The tumor size exceeding 25 mm (Exp (B) = 0.179; 95% CI = 0.05-0.7; p = 0.014), severe dysplasia (Exp (B) = 0.113; 95% CI = 0.03-0.4; p = 0.001) and fold convergence (Exp (B) = 0.2; 95% CI = 0.07-0.7; p = 0.015) are independent risk factors for disease recurrence.Conclusion: mucosectomy is indicated for colon adenomas if its size does not exceed 25 mm and can be removed en bloc.