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The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

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The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

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AIM: To present single-center experience and results of surgical treatment of acquired tracheal stenosis. MATERIAL AND METHODS: There were 99 patients with acquired tracheal stenosis for the period from January 2008 to December 2017. Median age was 39 (28; 55) years (range 19-79 years), male/female ratio - 64/35. There were 59 patients with tracheostomy-related stenosis, 31 - post-intubation injury, 6 - posttraumatic stenosis, malignant and idiopathic stenosis was observed in 2 and 1 patients, respectively. Single-stage circular tracheal resection or staged surgical approach were preferred depending on localization and severity of stenosis, respiratory function at admission, severity of concomitant diseases and possibility of prolonged head adduction, presence of tracheostomy and cervical tissues inflammation, functional state of laryngeal structures. RESULTS: Single-stage circular tracheal resection was applied in 44 (44.4 %) out of 99 cases. In 55 (55.6%) patients staged approach was preferred: Montgomery T-tube placement followed by tracheoplasty after 6-12 months - 27 patients; tracheoplasty on prefabricated endotracheal stent - 8 patients; staged endotracheal treatment (including Dumon prosthesis deployment) - 12 patients. In 11 cases circular resection was done as a final stage of treatment. There was no in-hospital mortality after circular tracheal resection. Morbidity included anastomotic dehiscence - 2 (3.6%), recurrent stenosis in 6 months after surgery - 1 (1.8%), granulation tissue growth followed by stenosis - 4 (7.3%), wound infection - 3 (5.5%) cases), postoperative pneumonia - 2 (3.6%) patients, respectively. CONCLUSION: Tracheal resection is preferred for tracheal stenosis management. Alternative techniques are life-saving procedures, but could potentially extent the length of stenosis and delay recovery of the patient.

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AIM: To present own experience of internal drainage and characteristics of its different variants which are applied in various countries. MATERIAL AND METHODS: Endosonography-assisted internal drainage of pancreatic pseudocysts was performed in 25 patients. Plastic stents were implanted in one stage without change of instruments while metal stents - with change of instruments during manipulation. RESULTS: Intervention was successful in 24 patients. In 1 case bleeding developed during cystostomy that required open surgery. Plastic and metal stents were used in 11 and 12 patients respectively. 1 patient had two pancreatic pseudocysts. Therefore 2 stents of both types were used in this case. Clinical success was achieved in 91% of cases. CONCLUSION: Different variants of method resolve problem of surgical approach, stomy and choice of stent. However every technique is targeted to resolve separate problem while single method is not accepted. Further large comparative studies are necessary to define optimal technique of internal drainage.

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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.

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The article states the results of examination and treatment of 57 patients with stenosis of the common bile duct of various genesis. The main aim of the work is criteria definition and evaluation of diagnostic significance of endosonography in the differential diagnosis of benign and malignant common bile duct stenosis. The paper presents a methodology of endoscopic ultrasound and basic criteria for the differential diagnosis of tumors and other lesions of the extrahepatic bile ducts. A comparative analysis of endosonography, ultrasound, CT, MRCP was conducted. The sensitivity of endosonography in determining the nature of the common bile duct stenosis was 97.7%, a specificity 100% and accuracy 98.2%, which is superior to other methods of radiological diagnosis. In comprehensive surgical centers endosonography should be used as a method of specifying the final diagnosis to determine the nature of the common bile duct stenosis, particularly at low constriction location.

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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.

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The publication presents the results of the examination and treatment of 82 patients with pancreatic adenocarcinoma. The main objective of the work is the evaluation of endosonography diagnostic significance in identifying tumor vascular invasion and determining resectability of the tumor. The paper describes an EUS methodology, type of echoendoscopes and ultrasound criteria for tumor invasion to the blood vessels. Vessel invasion during endosonography was suspected in 48 (58.5%) cases, according to surgery data, tumor invasion into upper abdomen vessels was detected in 51 patients (62.2%). Sensitivity of endosonography in detecting vessel invasion was 90.2%, specificity--93.5%, accuracy--91.5%. Endosonography being in trend of present day ideas about the criteria of pancreatic cancer resectability is the leading method in the selection of patients to surgery.

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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.

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15 patients with solid-pseudopapillary tumors of the pancreas (SPTP) were investigated. There were no specific clinical signs of the disease revealed; the major common clinical sign was the upper abdominal pain. Of the diagnostic methods the ultrasound together with endoscopic ultrasound, computed tomography and magnetic resonance imaging were used. Specific diagnostic feature of SPTP is the heterogenous structure and even contours and capsule. Any changes of pancreatic duct are untypical. All 15 patients were operated on. The intraoperative urgent histological analyze together with postoperative immunohystochemical investigation were performed in all cases. 11 patients developed the postoperative pancreatitis. The long-term follow up results were obtained in 15 patients. The disease progression was registered in one case.

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15 patients with intraductal papillary-mucinous tumors (IPMT) of the pancreas were observed. Clinical manifestation corresponded with chronic pancreatitis. Ultrasound study, including endosonography, contrast-enhanced computer and magnetic resonance tomography were used in complex observation of the patients. Dilation of main or lateral pancreatic ducts, connection of tumor with pancreatic duct system and absence of septal calcinosis are typical signs in radiodiagnostics of IPMT. Visualization of parietal papillary proliferations and their contrast enhancement are undeniable signs f or neoplastic character of pancreatic duct dilation. Sensitivity of CT, MRТ and endoUS amounted accordingly 66, 83 and 88%. All patients were operated. Extent of operation was determined by morphological character, localization and size of the tumor (pylorus-preserving pancreaticoduodenal resection was carried out to 6 patients, distal resection including robot-assisted - to 7 patients, midline resection - to 1 patient, duodenum-preserving resection of head and body of pancreas - to 1 patient). Intraoperative urgent histologic study of pancreatic section was carried out by all means. Tumors with borderline degree of malignancy were detected in 4 cases.

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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.

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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.

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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.

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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%.

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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.

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