Immediate Results of Colonic Flat Epithelial Neoplasms Removal Using Diathermic Snare Endoscopic Mucosal Resection and Mucosectomy Combined with Dissection in the Submucosal Layer: Comparative Assessment

Aim: to compare the immediate outcomes of removing colonic flat epithelial neoplasms by using diathermic snare endoscopic mucosal resection (EMR) and mucosectomy with endoscopic submucosal dissection (ESD).Materials and methods. Ninety-six endoscopic procedures were conducted on the colon of 93 patients with flat epithelial neoplasms. The mean age of patients was 64.9 ± 10.7 years, with an age range of 39 to 88 years. The size range of epithelial neoplasms was 20 to 70 mm, with a median of 37.4 ± 14.8 mm. Only patients with benign epithelial neoplasms were included in the study since patients with suspected malignancy in laterally spreading tumors are indicated for ESD intervention to avoid fragmentary excision and risk of colorectal cancer progression due to possible positive resection margins. The patients were separated into two equally sized groups and treated with EMR and ESD methods.Results. Epithelial neoplasms in the ESD group had an average size of 41.6 ± 15 mm while those in the EMR group had an average size of 33.1 ± 13.5 mm. The ESD group had an average intervention time of 143.6 ± 102.9 min, whereas the EMR group had an average intervention time of 52.6 ± 34.4 min. Both groups (96 adenomas) had a total of 10 (10.4 %) patients who experienced colonic perforations during the intervention, with 4 (4.1 %) cases observed in the EMR group and 6 (6.2 %) in the ESD group. No statistically significant differences were identified in the occurrence of perforations during the operation (p = 0.7401). ESD resulted in an en bloc removal rate of 44/48 (91.6 %), whereas EMR only achieved a rate of 14/48 (29.1 %).Conclusion. Endoscopic mucosectomy with submucosal dissection (ESD), in contrast to endoscopic mucosal resection (EMR) with diathermic snare, provides a higher frequency of tumor removal en bloc, regardless of tumor size, but is characterized by a longer duration of intervention (p < 0.0001). In the ESD group, there were twice as many intraoperative bleedings (p = 0.0061) due to the longer duration and technical complexity of the procedure. There were no statistically significant differences in the incidence of late complications between the groups (p = 0.9999). Local recurrence of adenoma developed in two patients (4.1 %) after pEMR, statistically significant differences were noted (p < 0.0006)

Colorectal Cancer in Patient with Functional Gastrointestinal Symptoms

Aim. A clinical observation to highlight the importance of detailed examination in patients with functional gastrointestinal symptoms.Key points. A 28-yo female patient was admitted with complains of left ileal pain, abdominal distention and up to 4-day stool delay. The complaints had long been interpreted as clinical manifestations of irritable bowel syndrome. No significant abnormalities were revealed in outpatient check-up (general and biochemical blood panels, stool test, abdominal ultrasound, oesophagogastroduodenoscopy). Colonoscopy was performed on admission, with diagnosis of rectal adenocarcinoma. The patient had a prompt surgical intervention, repeated courses of polychemotherapy and is currently followed by an oncologist and coloproctologist. No relapse signs have been reported.Conclusion. Patients with the complaints satisfying the Rome Criteria Revision IV for functional gastrointestinal diseases should have a thorough examination as per recommendations of the Russian Gastroenterological Association and Russian Association of Coloproctologists

Clinical and Morphological Features of Dysplasia and Early Gastric Cancer in the Patients with Autoimmune Gastritis

Аim: to analyze a series of cases of dysplasia and early gastric cancer developed in patients with autoimmune gastritis (AIG), and to identify their clinical and morphological features.Materials and methods. The study included six cases of detection of early gastric cancer on the background of AIG. Four out of six patients underwent endoscopic treatment, and in three out of six cases patients underwent endoscopic mucosectomy with dissection in the submucosal layer. One patient underwent endoscopic surgery in 2017, he continues annual dynamic follow-up without signs of tumour recurrence. A female patient with type 1 neuroendocrine tumour and mild dysplasia is awaiting treatment.Results. In five out of six patients with AIG, the localization of lesions prevailed in the stomach body, while all detected tumours were early ones, and according to the immunophenotype — of a gastric type. The presented cases of tumours were not accompanied by hyperplasia of neuroendocrine cells directly in the area of the tumour itself, but only in the surrounding gastric mucosa. Additionally, several cases of early gastrointestinal stromal tumours were found, which were characterized by low proliferative activity and had small sizes.Conclusion. The predominance of pseudopyloric metaplasia in the surrounding mucosa allows us to consider pseudopyloric metaplasia as a potentially significant change in the gastric mucosa of patients with AIG that may precede the development of gastric cancer

Modern Approaches to the Diagnosis and treatment of <i>Clostridioides difficile (C. difficile)</i>-associated Disease in Adults (literature Review and Expert Council Resolution)

Aim: to review the modern approaches to the diagnosis and treatment of C. difficile-associated disease in adults and present the resolution of the Expert Council held on March 25, 2023 in Moscow.General provisions. C. difficile is the most important nosocomial pathogen which spores are also commonly found in the environment. Microbiota impairment, primarily due to the use of antibacterial drugs, is a key stage in the development of C. difficile-associated disease. A search for an infection should be carried out only in patients with diarrhea, and it is advisable to use at least 2 laboratory methods. The drug of choice for first-line treatment is vancomycin. If drug treatment is ineffective or the patient has recurrent clostridial infection, fecal microbiota transplantation should be considered. The probiotic strain Saccharomyces boulardii CNCM I-745 has a direct inhibitory effect on C. difficile toxin A, promotes normalization of the intestinal microbiota composition, and decreases the inflammatory reaction in colonic mucosa colonized with a toxigenic strain of C. difficile.Conclusions. Addition of the probiotic strain Saccharomyces boulardii CNCM I-745 to antibacterial therapy promotes both primary and secondary prevention of C. difficile-associated disease

Иммуноглобулин G4-ассоциированные заболевания c поражением легких

Lung involvement in IgG-related diseases is poorly investigated. The current approach to IgG-related diseases including IgG-related lung disease was discussed in the article. The authors described recent classification and diagnostic criteria of IgG4-related lung disease, including radiological, serological and morphological parameters, and therapeutic approaches. Two clinical cases of IgG4-related disease with involvement of the lungs (organizing pneumonia), lacrimal glands (dacryoadenitis), kidneys (tubulointerstitial nephritis), eyes (iridocyclitis), and salivary glands (sialadenitis) were described in the article. Immunosuppressive therapy was successful in both cases. Среди всех IgG4-ассоциированных заболеваний (IgG4-АЗ) легочные поражения являются наименее изученными практическими врачами. В обзоре изложен современный взгляд на проблему IgG4-АЗ, в т. ч. с поражением легких. Подробно изложена современная классификация вариантов легочной патологии, а также диагностические критерии, включающие рентгенологические, серологические и морфологические параметры; рассмотрены подходы к лечению IgG4-АЗ легких. Приводятся 2 собственных клинических наблюдения IgG4-АЗ с поражением легких (организующаяся пневмония), слезных желез (дакриоаденит), почек (тубулоинтерстициальный нефрит), органа зрения (иридоциклит) и слюнных желез (сиалоаденит). Продемонстрированы хорошие результаты иммуносупрессивной терапии, проведенной в обоих случаях

A Case of Medullary Carcinoma of the Jejunum Combined with the Intestinal Lymphangiectasia Accompanied by the Malabsorption Syndrome

Aim: to present a clinical and morphological observation of an extremely rare combination of medullary carcinoma of the jejunum and intestinal lymphangiectasia in a 33-year-old patient with clinical features of malabsorption syndrome over the 10 years.Key points. An autopsy revealed a tumor formation spreading from the wall of the jejunum to the mesentery, with metastases to the mesenteric lymph nodes. The medullary carcinoma with positive expression of СD117, DOG1, EMA, PanCK, PDL-1, vimentin, mosaic non-intense expression of CA19-9, calretinin, CD10, CDX2, CEA, MUC-5AC, SATB2, and negative reaction to ALK, CD3, CD8, CD20, CD30, CD31, CD34, CD45, CD56, chromogranin, CK7, CK20, desmin. The proliferative index was high: Ki-67 &gt; 80 %. Moreover, during the histological examination of the intestinal wall, intestinal lymphangiectasia complicated by the malabsorption syndrome was revealed.Conclusion. The uniqueness of this clinical and morphological case is in the combination of medullary carcinoma of the jejunum metastasized to the mesenteric lymph nodes with the underlying intestinal lymphangiectasia accompanied by the development of malabsorption syndrome

Seborrheic keratosis and warts in patient with ichthyosis vulgaris

A case of the patient 69-years with ichthyosis vulgaris, seborrheic keratosis and warts is described. Supervision by interestingly atypical picture of hereditary dermatosis at the patient with insulin resistance that can be considered as a provocative factor of development seborrheic keratosis and warts

Duodenal Ulceration in a Child with Coeliac Disease

Coeliac disease (CD) is a gluten-dependent inflammatory disease of the small bowel that affects up to 1% of the global population. Herein, the presence of ulcers, erosions, or strictures in the duodenum for non-advanced cases of CD is a rarity. Case report: We present a clinical case of a 17-year-old girl, who from the age of 9, had suffered from erosive Helicobacter pylori (HP)-associated gastritis and erosive duodenitis. At 16, she was diagnosed with a duodenal ulcer, complicated by cicatricial deformity of the bulb. While an atypical course in the development of the disease had led to the initial delay in diagnosis, a serum study and an intestinal biopsy confirmed CD. Discussion: A recent study found an elevated rate of peptic ulcer disease in patients with CD. From literature searches, comorbid HP infection and CD have indeed been widely reported, whereas cases highlighting the prevalence of CD-associated peptic ulcers have been observed and reported in only a few instances. Consequently, greater awareness is warranted and must be exercised for identifying the origins of ulcerative lesions that may be CD-related or -derived

Modern Approaches in the Morphological Diagnosis of Inflammatory Bowel Diseases

The purpose of the review: to summarize the main data of the literature and our own accumulated practical experience of everyday diagnosis of inflammatory bowel diseases (IBD) to better represent the morphological features and histological conclusions.Key points. The microscopic picture of IBD is often represented by a combination of basic histological characteristics that can be detected in other diseases and only in rare cases can be considered pathognomonic. No single histological feature can be used in isolation to diagnose ulcerative colitis or Crohn’s disease. Diagnostic accuracy is improved if several signs are taken into account at once, if changes within one or more parts of the intestine are analyzed, it is necessary to compare the identified changes with the clinical picture of the disease.Conclusion. The presented stages of the morphological study of biopsy specimens in patients with IBD and the exact characteristics of the detected changes will help to increase the diagnostic value of the study of ileo- and colonobiopsies, as well as improve mutual understanding between gastroenterologists and pathologists and, as a result of interaction between specialists, will increase the accuracy of the diagnosis

The role of hepatic biopsy in liver graft evaluation during liver procurement

Abstract. Using a steatotic graft in liver transplantation (LT) can lead to a poor function and high mortality. The role of the rapid liver graft biopsy processing was studied. The liver grafts of potential donors were assessed for hepatic steatosis.Material and methods. The study included 341 cases of cadaveric donor liver transplantations. Patients were divided in two groups: the study group where the rapid graft biopsy processing was performed (n=163) and the comparison group (n=178) without biopsy processing. Livers with macrosteatosis of over 50% of graft parenchyma or with severe necrosis and structural damage were discarded.Results. The rates of ischemic reperfusion injury (IRI), initial poor graft function (IPGF), and primary graft nonfunction (PNF) were significantly lower in the study group. There were no significant differences between two groups in cold ischemia time.Conclusion: rapid histological examination provides a useful tool to avoid life threatening LT complications such as severe IRI, IPGF, and PNF