Transtumoral endoprothesis in surgery of colorectal cancer, complicated with colonic obstruction: advantages and disadvantages. A review of the literature

A multifactorial analysis of the literature data on the treatment of acute tumor colonic obstruction using minimally invasive endoscopic surgical technology was carried out. On the basis of the analysis of special publications, the effectiveness of stenting of the large intestine, as a minimally invasive endoscopic method of decompression, is presented. Indications and contraindications for colorectal stenting, advantages and disadvantages, possibilities and prospects of endoscopic decompression of the colon are described in detail. It is postulated that stenting, used in acute tumor obstruction of the colon as a «bridge to surgery», being a worthy alternative to classical colostomy, allows an effective antegrade decompression of the colon and prepares the patient to surgical treatment with the performance of oncological justified primary radical and one-stage restorative operations in more optimal conditions with minimal risk. It is shown that in the late stages of the malignant process and in the presence of neresect-leucorrhoea colorectal cancer, as well as in the presence of absolute contraindications to a radical surgeon Colon stenting can serve as the final treatment for inoperable patients.

Causes of Melena and Effective Examination Strategies in Children

Background and Aim: Melena, or tarry black stool, is not a rare symptom encountered in pediatric clinical practice, and the bleeding source varies from the upper gastrointestinal tract to the small intestine. Endoscopy is effective in identifying bleeding, but it does not always identify the source of bleeding. Endoscopic examination in children is commonly challenging, and there are no detailed reports about the causes of melena in children. This observational study aimed to validate the cause of melena in children and to investigate more effective and less burdensome examination methods.Methods: We retrospectively reviewed the clinical records of 55 patients who underwent examination for melena.Results: In this research, 38 patients had underlying diseases such as malignancy and severe mental and physical disorders. The bleeding source was identified in 39 patients. The most common final diagnosis was duodenal ulcer (n = 22), and the other diagnoses were gastric ulcer, esophagitis, and esophageal varices. The upper gastrointestinal tract was the most common source of bleeding (n = 34). In five patients, the bleeding source was the small intestine. Vomiting, abnormal abdominal ultrasonography findings, and a hemoglobin level of ≤ 3 g/dL than the lower normal limit were significant factors indicating that the bleeding source can be found on esophagogastroduodenoscopy.Conclusions: The upper gastrointestinal tract was the most common bleeding source of melena in children. As in adults, esophagogastroduodenoscopy is the primary endoscopic method of choice. Furthermore, small bowel capsule endoscopy may be useful in identifying the bleeding source in children without upper gastrointestinal lesions.

Endoscopic ultrasonography in the diagnosis of pathology of the gastrointestinal tract

Endoscopic ultrasonography is a relatively new endoscopic method of examination to determine the invasion of tumors of the gastrointestinal tract, detection and sizing of pancreatic tumors, diagnosis of chronic pancreatitis, pathology of the biliary tract. The method combines the possibilities of two studies: endoscopic and ultrasound. The study is performed using a video endoscope, at the end of which is a scanning ultrasound sensor. The advantages of endoscopic ultrasound over traditional ultrasound examination through the anterior abdominal wall are that the ultrasound sensor under visual control through the lumen of the digestive tract can be carried out directly to the investigated object. The use of very high frequencies of ultrasound provides high image quality with a resolution of less than 1 mm, inaccessible to other research methods (ultrasound, computer tomography and magnetic resonance imaging, endoscopic cholangiopancreatography).

Effect of the botulinum toxin injections and endoscopic pneumocardiodilation on symptoms severity and treatment outcomes among patients with primary esophageal sphincter achalasia

Achalasia is a disorder of esophageal motility, which is manifested by symptoms of dysphagia, belching undigested food, respiratory symptoms (night cough, recurrent aspiration and pneumonia), chest pain and weight loss. Aim of the study. To determine the possibilities and clinical effectiveness of combined approaches in the treatment of cardiac achalasia using endoscopic pneumocardiodilation and injections of botulinum toxin type A "Dysport" at various stages of the disease. Materials and methods. Injections of the drug botulinum toxin type A "Dysport" and balloon endoscopic pneumocardiodilation (EPCD) were used. The contents of the vial with botulinum toxin were diluted in 0.9% sodium chloride solution to obtain a solution containing 60 UA in 1 ml. In each of the four quadrants of the LES, 2 injections of 0.5 ml of the drug "Dysport" were made with a concentration of a solution of 30 UA in 0.5 ml at a distance of 1 cm from one another. The total dose was 250 units. The technique of isolated EPCD, was carried out with a Witzel balloon dilator, 40 mm in diameter, it required a thorough preoperative examination of the patient, including an assessment of the general condition, the presence and severity of body weight deficiency, water-electrolyte, protein, achlorhydric manifestations of the disease, as well as the propulsive ability of the esophagus through X-ray examination. Results. The combined endoscopic method significantly improves the results of treatment of esophageal cardiac achalasia, having a direct impact on the pathogenetic mechanisms of its development. Given the effectiveness of treatment of esophageal cardiac achalasia by botulinum toxin injection and pneumocardiodilation, this method can be used in patients with comorbid pathology and high surgical risk as an alternative to laparoscopic Heller procedure (cardiomyotomy), especially in older patients. Unsatisfactory results of the combined endoscopic method of treatment of stage III-IV cardiac achalasia for up to 2 months are an indication for surgical treatment of this pathology. Conclusions. Given the significant increase in knowledge about this nosology in recent years, there is a need for a comprehensive, evidence-based study of new promising treatments for patients, covering all aspects of the disease.

Endoscopic measurement of nasal septum perforations

Background Nasal septum perforations (NSP) have many uncomfortable symptoms for the patient and a highly negative impact on quality of life. NSPs are closed using patient-specific implants or surgery. Implants are created either under anesthesia using silicone impressions or using 3D models from CT data. Disadvantages for patient safety are the increased risk of morbidity or radiation exposure. Materials and methods In the context of otorhinolaryngologic surgery, we present a gentle approach to treating NSP with a new image-based, contactless, and radiation-free measurement method using a 3D endoscope. The method relies on image information only and makes use of real-time capable computer vision algorithms to compute 3D information. This endoscopic method can be repeated as often as desired in the clinical course and has already proven its accuracy and robustness for robotic-assisted surgery (RAS) and surgical microscopy. We expand our method for nasal surgery, as there are additional spatial and stereoperspective challenges. Results After measuring 3 relevant parameters (NSP extension: axial, coronal, and NSP circumference) of 6 patients and comparing the results of 2 stereoendoscopes with CT data, it was shown that the image-based measurements can achieve comparable accuracies to CT data. One patient could be only partially evaluated because the NSP was larger than the endoscopic field of view. Conclusion Based on the very good measurements, we outline a therapeutic procedure which should enable the production of patient-specific NSP implants based on endoscopic data only.

Multi-layer endoscopic suturing: a novel method of gastric fistula closure

Background and study aims Current endoscopic methods of treating gastric fistulas are either too complex or have high rates of recurrence. We aimed to provide a novel endoscopic method for robust fistula closure. Patients and methods This was a single-center, retrospective study of five patients who underwent multi-layer endoscopic suturing for closing of a chronic fistula (> 4 weeks). Devitalization of the fistula tract was achieved with argon plasma coagulation, followed by endoscopic suturing of the fistula. Then, endoscopic suturing of the gastric wall surrounding the fistula was performed, creating an overlay of healthy gastric mucosa around the fistula. Results Technical success (fistula closure on the day of the procedure) was achieved in all five patients, with no complications. After a median follow up of 5 months (range 2–23 months), there was a 100 % clinical success rate (no fistula recurrence). Conclusions Our single-operator method of multi-layer endoscopic suturing provides a robust fistula closure with minimal to no risk of recurrence. In light of limitations of current fistula closure methods, further investigations are warranted to better define long-term outcomes with it compared to alternative methods.

Мinimally invasive stent technologies in hepatopancreatobiliary surgery

Aim. To compare the aspects of the use of various stents in hepatopancreatobiliary zone diseases.Materials and methods. We analyzed the experience of using biliary plastic and metal self-expanding stents placed by the antegrade percutaneous (n = 45) or retrograde endoscopic method (n = 160). Pancreatic stenting with 5 Fr plastic stents was performed in 35 patients.Results. Our experience shows the high efficiency of stenting performed by antegrade and endoscopic retrograde access for bile and pancreatic ducts obstruction. Pancreatic stenting is justified in the prevention of acute pancreatitis (in the presence of a risk factor) and in treatment of post-ERCP pancreatitis, as well as in the treatment of acute biliary pancreatitis with impacted stone in papilla Vater.Conclusion. Minimally invasive technologies has a leading role in the treatment of patients with ductal failure of the hepatopancreatobiliary zone. Stenting should be used to prepare for radical surgery or as a final palliative treatment method. A differentiated approach is important in selecting a stent, depending on the specific clinical task. For biliary drainage in patients with obstructive jaundice of various etiologies, it is permissible to use both the retrograde and antegrade stenting. The choice of the decompression method depends on the level of the biliary obstruction, the cause of obstructive jaundice, the technical equipment of the department and the training of specialists in retrograde and (or) antegrade endobiliary technologies. Antegrade access is preferred for proximal obstruction of the bile ducts, retrograde endoscopic access is preferred for distal obstruction.

Papillary squamous cell carcinoma successfully treated with bronchoscopic intratumoral injections of cisplatin and Endostar: a case report

Squamous cell carcinoma (SCC) is a malignant epithelial tumor originating from the bronchial epithelium that shows keratosis and/or intercellular bridges. Papillary squamous cell carcinoma (PSCC) is an extremely rare subtype of SCC that manifests with a unique intrabronchial papillary growth pattern. Surgical resection is still the first recommendation for localized noninvasive SCC. However, some patients are not candidates for surgical resection. With the development of interventional pulmonology, bronchoscopic interventional therapy has played a key role in the treatment of central airway tumors. Here, we report a case of noninvasive PSCC in the airway treated with an electric snare, argon plasma coagulation (APC), and cryotherapy. After removing the tumor by electrotomy, cryotherapy, and APC, the tumor was injected with Endostar 15 mg (3 ml) and cisplatin 20 mg (diluted to 3 ml with 0.9% normal saline) in six separate sites, once every 21 days. The tumor was eliminated, and the treatment was stopped after four treatment cycles. During the 1-year follow-up, there was no recurrence of PSCC in the airway. In this case, submucosal injections of Endostar combined with cisplatin was a feasible and effective endoscopic method for treating a low-grade intratracheal malignant tumor.

Is gallstone disease a “disease of well-being”?

Gallstone disease (choledocholithiasis) is a pathological condition in which stones are formed in the gallbladder. It is caused by a change in the chemical composition of bile with an increase in the concentration of cholesterol in it, hypomotility of the gallbladder, and a number of metabolic disorders. This disease is widespread throughout the world: according to literary sources, about 10% of the population suffers from it. The lowest prevalence of cholelithiasis is noted in the countries of Africa and Asia, which is associated with dietary habits and the absence of high-calorie foods in the diet. In the structure of the overall morbidity, cholelithiasis ranks third after lesions of the cardiovascular system and diabetes mellitus, and exacerbations of cholelithiasis are one of the main reasons for hospitalization with acute surgical pathology. As a rule, women get sick 3-4 times more often than men. If the conservative treatment is ineffective, surgical intervention is necessary; at the present stage, minimally invasive methods with the use of laparoscopic techniques are becoming increasingly popular. To increase the effectiveness of the endoscopic method of treatment, various methods of contact biliary lithotripsy - laser, mechanical, electrohydraulic [2] - are often used.