AIM: to clarify endoscopic features that differentiates juvenile polyps from other types of polyps in patients with juvenile polyposis syndrome.

PAIENTS AND METHODS: the retrospective cohort study included 30 patients who met the clinical criteria for juvenile polyposis syndrome in Jan 2012 — Dec 2024. A total of 1026 colorectal neoplasms were analysed comparing endoscopic and morphological images. Endoscopic features that have a significant impact on the determination of juvenile polyps were assessed. The following factors were estimated: size, site, Paris classification criteria, polyp surface, discrepancy with the adenomatous pattern, presence of whitish pits.

RESULTS: the most important features are smooth surface, distinguished from adenomatous polyps include discrepancy with the adenomatous surface pattern according to the classifications of Kudo-Sano, as well as the presence of whitish pits of a round, irregular or elongated shape (p < 0.001). These criteria allow to determine with a probability of up to 80% that the detected neoplasm will be a juvenile polyp. The endoscopic diagnostic method has a high sensitivity of 93.9% (95% CI: 89.1–97.0) and a negative predictive value of 90.7% (95% CI: 83.5–95.4) in detecting juvenile polyps.

CONCLUSION: endoscopic features of juvenile polyps (smooth surface, the discrepancy with the adenomatous surface pattern according to the classifications of Kudo S. and Sano Y., as well as the presence of whitish pits of a round, irregular or elongated shape) were identified.

AIM: to evaluate the two-year survival of therapy with biosimilars of ioftiximab and adalimumab in patients with Crohn's disease (CD).

PATIENTS AND METHODS: survival was assessed by primary medical records (electronic medical records) of patients with CD who started on adalimumab or infliximab therapy in 2017-2019. Forty-nine patients who received infliximab therapy and 39 patients who received adalimumab therapy were included in the study. The main clinical and demographic data, laboratory tests (hemoglobin, leukocyte, platelet, albumin, C-reactive protein and fibrinogen levels) and instrumental checkup (ileocolonoscopy, intestinal ultrasound, CT enterography or MR enterography) at the time of therapy initiation andfor 2 years were estimated. In addition, the needfor therapy optimization during this period, the frequency and reasons for therapy discontinuation are assessed. In the context of the retrospective analysis, the "number of involved segments" (NIS) index was included. By this index, we meant the number of anatomical segments of the intestine to which the active inflammatory process was determined (duodenum, jejunum, ileum, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum).

RESULTS: in patients with infliximab for 2 years, the intensity of the inflammatory process significantly decreased. The number of intestinal segments involved in the inflammatory process and endoscopic activity significantly decreased during all 2 years of therapy (p <0.001 for both indices), the level of hemoglobin and plasma albumin significantly increased (p = 0.004 and p = 0.025, respectively). The median survival of therapy was 19 (9;24) months and the treatment continued for more than 2 years in 44.9% of patients. During adalimumab therapy of patients with CD, a significant decrease in all parameters of the inflammatory process activity was detected, the number of inflamed intestinal segments (p <0.001), intestinal wall thickness (p < 0.001), C-reactive protein (p < 0.001). The median survival of therapy was 24 (12; 24} months, 55.1% of patients continued to receive adalimumab for more than 2 years. At the same time, during infliximab and adalimumab therapy, the frequency of complications of CD increased (p < 0.001) due to strictures (p <0.001). This is probably explained by the healing of transmural ulcerative defects with the formation of cicatricial deformation of the intestine.

CONCLUSION: the study of predictors of high survival of biotherapy in patients with IBD is quite promising. Based on the results of retrospective analysis, several promising areas for prospective studies have been identified.

AIM: to work out artificial neural networks (ANNs) for the screening and differential diagnostics of inflammatory bowel diseases (IBD) based on the analysis of clinical and laboratory data.

PATIENTS AND METHODS: the study retrospectively evaluated the clinical manifestations, medical history and laboratory data of patients with irritable bowel syndrome (IBS), ulcerative colitis (UC), and Crohn’s disease (CD) with colonic involvement during exacerbation. The most typical characteristics for each patient group (IBS-IBD, UC-CD) were estimated and were used to construct the models. In order to create ANNs that could make a decision on the presence of IBD and provide a differential diagnosis of UC and CD, we used simple neural networks multilayer perceptrons (MLP) and radial basis functions.

RESULTS: the MLP 13:13-5-1:1 identified IBD in the test sample with a sensitivity of 89.3% and a specificity of 100%. Across the entire dataset, the model demonstrated a sensitivity of 92.7% and a specificity of 99.0%. The highest accuracy for the differential diagnosis of UC and Crohn’s disease CD was observed with the MLP 9:9-8-1:1, which identified 76.81% of CD cases and 86.67% of UC cases in the test sample. Across the entire dataset, the model detected 70.16% of CD cases and 86.40% of UC cases.

CONCLUSION: the ANNs demonstrated high efficacy in identifying IBD and moderate performance — in the differential diagnosis of UC and CD. Following validation, the model may serve as a convenient tool for screening inflammatory bowel diseases in clinical practice.

AIM: to compare the one-year efficacy of upadacitinib (UPA) and tofacitinib (TOFA) for moderate to severe attacks of ulcerative colitis (UC).

PATIENTS AND METHODS: a retrospective study included electronic medical records of patients who were initiated by UPA and TOFA for the treatment of UC between January 2022 and January 2023. In consisted of 74 patients (37 in each group). In all patients, demographic data were assessed, the severity of the attack was assessed using the partial Mayo index, laboratory data, endoscopy at the start of therapy (day 0), at the 8th, 26th and 56th week of therapy, the incidence and nature of adverse events for the period of therapy. In order to create comparable groups for endoscopic activity before the start of therapy, the method of optimal pairing was used.

RESULTS: endoscopic response was found in 10/34 (29%) patients in the TOFA group and 18/36 (50%) in the UPA group (p = 0.08) when assessing changes in the endoscopic picture between 8 and 0 weeks of therapy; 14/30 (47%) on TOFA and 13/29 (45%) on UPA (p = 0.9) between 26 and 8 weeks; 6/26 (23%) on TOFA and 13/28 (46%) on UPA (p = 0.09) between 56 and 26 weeks, respectively. In the TOFA and UPA groups, endoscopic remission by week 56 was achieved in 18/26 (69%) patients and 15/28 (54%) patients, respectively. Secondary outcomes data did not reveal a significant difference between the 2 groups regarding optimization of therapy or the need for surgery. Laboratory data, as well as the severity of UC, did not differ between groups at all time control points.

CONCLUSION: endoscopic response and remission were not statistically different between the two groups. A randomized, prospective study is needed to compare the efficacy of upadacitinib with tofacitinib.

AIM: to estimate early results and feasibility of simultaneous laparoscopic procedures for patients with colorectal cancer (CRC) with synchronous liver metastases.

PATIENTS AND METHODS: the pilot study included 11 patients with CRC with synchronous liver metastases. They underwent simultaneous procedures using a laparoscopic approach. The inclusion criteria were morphologically confirmed CRC, synchronous resectable liver mts and somatic status level ASA I-II.

RESULTS: no conversions occurred. The operation time was 194.0 ± 36.5 (170–250) min., intraoperative blood loss was 350.0 ± 175.3 (150–600) ml. Anatomical resections were performed in 7 of 11 cases: hemihepatectomy in 2 cases, bisegmentectomy in 2 cases, and resection of a liver segment in 1 case. The postoperative hospital stay was 9.9 (5–20) days. There were no blood transfusions, there was 1 complication — anastomosis leakage. No mortality occurred.

CONCLUSIONS: simultaneous colorectal resection with liver resection using laparoscopic access is a feasible and safe method if strict patient selection criteria are met.

AIM: to develop and evaluate standardized approach for bowel cleansing before colonoscopy.

MATERIALS AND METHODS: a cross-sectional study using the Delphi method was used. Anonymous voting was done by 12 experts. Twelve questions were compiled on bowel cleansing before colonoscopy. Based on the practical experience of the working group, as well as literature data, ten statements were formulated. Recommendations that did not reach the required level of agreement (80% or more) will be subject to a 2nd round of Delphi voting.

RESULTS: voting was completed on all 10 selected theses, the expert panel participated in full. Of the 10 provisions submitted for voting, consensus (80% or more) was reached on the stages of cleansing, diet and the use of additional agents.

CONCLUSION: the developed standardized scheme of patient preparation for colonoscopy is recognized as the most optimal in clinical practice based on expert evaluation.

AIM: to estimate the actual clinical practice of hemorrhoidal disease treatment among Russian doctors.

PATIENTS AND METHODS: the questionnaire with detailed questions on the management of patients with haemorrhoids in the perioperative period was distributed electronically through the ProctoWeb educational project and by the authors from 12.01.2024 to 30.06.2024. The study included responses from coloproctologists or surgeons who perform open hemorrhoidectomy.

RESULTS: seventy-eight responses were obtained and 84.6% of participants were coloproctologists in private (53.8%) or city hospitals (24.4%). More than a half (56.4%) of respondents prescribe preoperative analgesia (Phlebotonics (38.5%), NSAIDs (28.2%) and Metronidazole (12.8%)). Monopolar or bipolar electrocoagulation is most often used for both skin dissection and vascular coagulation with setting of instrument’s power of 20–40 Watt on the COVIDIEN FORCE TRIAD energy platform by a half of participants. The majority (82.0%) don’t use additional coagulation, 64.1% don’t insert a swab into the anal canal after hemorrhoidectomy. 75.6% of respondents routinely prescribe postoperative anesthesia (NSAIDs (98.7%), local anesthetics (60.3%), phlebotonics (53.8%), paracetamol (41.0%)).67.9% of respondents prescribe analgesics according to their own standard regimen, 44.9% of respondents apply a multimodal analgesia. 78.2% of respondents initially prescribe non-opioid drugs prior to prescribing opioids, 19.2% of participants prescribe opioid analgesics as planned postoperative pain management. The indication pain level for prescribing tramadol for more than 40% of respondents is 6–7 points according to VAS, and for most of others — 8 points. Less than 15% of respondents usually prescribe tramadol before the discharge. There were no significant differences in the perioperative management tactics between doctors from private, city and regional hospitals.

CONCLUSION: we have described the actual clinical practice of open hemorrhoidectomy in Russia. Most doctors adhere to current trends in the perioperative management of patients with haemorrhoids, however, some statements still remain controversial regarding the feasibility and safety.

AIM: to assess early efficacy and tolerability of preoperative chemotherapy combined with targeted therapy in patients with rectal cancer (RC).

PATIENTS AND METHODS: a pilot prospective study including 22 RC patients with KRAS wild-type gene is ongoing from 2021. There are 13 (59.1%) females and 9 (40.9%) males. Stage II RC was diagnosed in 2 (9.1%) patients and stage III RC in 20 (90.9%) patients. All patients received 6 cycles of mFOLFOX 6 chemotherapy combined with cetuximab targeted therapy followed by surgery. After completion of surgical treatment, patients with T4 and/or N + received adjuvant chemotherapy for 6 months (taking into account the time of preoperative treatment).

RESULTS: the completion rate of preoperative treatment was 90.9%, and a 15% reduction in drug dosages was required in 9.1% of patients. Adverse events were observed in 45.4% of patients. Grade III toxicity was noted in 13.6% of patients (neutropenia in 9.1% and skin rash in 4.5%). The clinical and radiological response to preoperative chemo-targeted therapy was 77.3%, including complete (9.1%) and partial (68.2%) tumor regression. All patients underwent radical surgery. The rate of postoperative complications was 13.6%. Grade I and grade IIIa complications (according to Сlavien-Dindo classification) were observed in 9.1% and 4.5% of cases. Pathological complete response (pCR, according to Mandard TRG 1) was achieved in 13.6% of patients, and good pathological response (TRG 1-2) was observed in 31.8% of patients.

CONCLUSION: preoperative chemotherapy combined with targeted therapy in RC patients with the wild type of the KRAS gene has a pronounced damaging effect on the tumor, and an acceptable toxicity profile does not affect intraand postoperative period. The short-term outcomes have been found to be encouraging. The study is ongoing to analyze the survival of patients.

AIM: to evaluate the efficacy and safety of Upadacitinib (UPA) — an oral selective janus-kinase 1 (JAK1) inhibitor in real clinical practice for the treatment of ulcerative colitis.

PATIENTS AND METHODS: in 2021-2023, as part of a multicenter, prospective, open, uncontrolled study, fortysix patients with mild-to-moderate ulcerative colitis (UC) were included (male: female ratio = 16:30, mean age 34 ± 3.1 years). Extraintestimal manifestation (EIM) initially was diagnosed in 7 patients (jonts and skin). Indications for UPA administration were: resistance to corticosteroids, ineffectiveness of basic and previously biologics treatment. The effectiveness was evaluated using the Mayo score, the Schroeder endoscopic index, as well as dynamic of hemoglobin, CRP and ESR. UPA was prescribed in accordance with the instructions for use: 45 mg for induction and 15/30 mg for maintenance therapy. The evaluation criteria were: the frequency of early primary clinical response within 1 week, the rate of clinical response/remission and endoscopic response/remission, the changes of EIM and the rate of adverse events (AE) in 8 weeks of induction and in 48 weeks of maintenance treatment.

RESULTS: all patients completed the induction course of UPA for 8 weeks. Early clinical response within 1 week with reduction of stool movements to 3 or less per day, absence of blood in stool was achieved in 25 (54.3%) patients. Clinical remission developed in 34 (73.9%) and clinical response in 3 (6.5%) of patients at the end of induction. Normal CRP and ESR levels and endoscopic remission was detected in 24 (52.2%) of patients in 8 weeks. The severity of EIM at the end of induction decreased in 4/7 (57.1%). One case of herpes zoster was registered as serious AE with drug withdrawal within the induction. The results of UPA maintenance therapy at week 48 were assessed in 16 patients. Clinical remission was maintained in 14/16 (87.5%) patients, with 11/16 (68.7%) of them receiving UPA at a maintenance dose of 30 mg per day, and 3/16 (31.3%) patients receiving 15 mg per day. In 2/16 cases (12.5%), clinical activity was maintained. Endoscopic remission developed in 10/16 (62.5%) patients, which was expressed in a decrease in the endoscopic Schroeder index decreases to ≤ 1 points, with 8 patients receiving a maintenance dose of 30 mg per day, and 2 patients receiving 15 mg per day. In the remaining patients, 4/16 (25%) (3 — UPA 30 mg, 1 — UPA 15 mg) cases had mild inflammation, and 2/16 (12.5%) (UPA 15 mg) had moderate activity.

CONCLUSIONS: in real practice, UPA allows to achieve an early clinical response, clinical and endoscopic remission after induction with good tolerability and safety in UC patients who refractory to corticosteroids and biologics.

AIM: to evaluate the effectiveness of endiscopic vac therapy in patients with rectal injuries.

PATIENTS AND METHODS: the retrospective study included 33 patients with rectal injuries treated with endoscopic vacuum therapy (EVT).

RESULTS: in 26/33 (78.8%) patients, treatment using EVT was successful and complete healing of intestinal wall defects developed. There was no sufficient deformation of the intestine or its severe narrowing in any case. In 2 (6.1%) cases it was possible to almost completely close the defect of the intestinal wall, but at the same time an internal fistula with abscess developed. The cavity was drained under ultrasound control. In 5 (15.2%) patients, the treatment failed. Three (9.1%) patients died, despite the good healing of defects in the rectal wall against the background of vacuum aspiration therapy.

CONCLUSION: the proper use of EVT can reduce the risk of wound infection and clean a highly infected area. As well it helps to reduce the rate of severe complications and minimizes the surgical procedure. The use of vacuum therapy in the early stages of surgical care can improve the results.

AIM: analysis of dynamic transrectal ultrasound (TRUS) and dynamic transperineal ultrasound (TPUS) accuracy in rectal intussusception (RI) diagnosis.

PATIENTS AND METHODS: a prospective cohort single-center diagnostic accuracy study of ultrasound for RI detection (January 2023 — October 2024) included 151 patients with obstructive defecation syndrome, without signs of complete rectal prolapse and without history of surgical treatment for pelvic floor descent syndrome. All patients underwent dynamic TRUS, dynamic TPUS and X-ray defecography. Ultrasound results were compared with X-ray defecography data.

RESULTS: according to the X-ray defecography, RI was detected in 126/151 (83.4%) patients, according to dynamic TRUS — in 108/151 (71.5%), according to dynamic TPUS — in 110/151 (72.8%), according to complex dynamic ultrasound — in 124/151 (82.1%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of dynamic TRUS in RI detection were 82.5% (95% confidence interval (CI): 74.8–88.7), 84.0% (95% CI: 63.9–95.5), 96.3% (95% CI: 90.8–99.0), 48.8% (95% CI: 33.3–64.5) and 82.8% (95% CI: 75.8–88.4), respectively, dynamic TPUS — 81.7% (95% CI: 73.9–88.1), 72.0% (95% CI: 50.6–87.9), 93.6% (95% CI: 87.3–97.4), 43.9% (95% CI: 28.5–60.3) and 80.1% (95% CI: 72.9–86.2), complex dynamic US — 92.1% (95% CI: 85.9–96.1), 68.0% (95% CI: 46.5–85.1), 93.6% (95% CI: 89.1–96.3), 63.0% (95% CI: 46.95–76.6) and 88.1% (95% CI: 81.8–92.8), no statistically significant differences were found.

CONCLUSION: ultrasound is a safe, highly sensitive method for RI detection in patients with obstructive defecation syndrome. Equivalent diagnostic accuracy of dynamic TRUS, dynamic TPUS and complex dynamic US allows using any available technique to detect RI. Complex dynamic US seems to be universal method for assessment the anatomical and functional state of rectum.

AIM: to find structural features and prerequisites for the development of complications of antitumor treatment of rectal cancer.

PATIENTS AND METHODS: for the analysis, a cohort of 302 patients was formed who were treated in 2017–2018. The inclusion criterion was verified rectal cancer. The study was retrospective, the primary endpoint was the complication rate of antitumor treatment. The distribution of patients by gender was almost equal: 148/302 (49.0%) women and 154/302 (51.0%) men. The age of patients ranged from 31 to 86 (65.2 ± 9.9) years. All 100% of patients underwent surgery for a rectal tumor. In 145 (48.0%) patients, treatment was limited to a surgical aid, in 28 (9.3%) — was supplemented with radiation therapy, in 86 (28.5%) — chemotherapy, in 43 (14.2%) a combination of all three treatment methods was used.

RESULTS: complications of antitumor treatment occurred in 118 (39.1%) patients. The vast majority of them — 95 (31.5%) cases — were postoperative. About half of them were associated with wound healing — 47 (15.5%). The most significant predictors of complications were the tumour differentiation (Area under the curve (AUC) = 0.58; 95% confidence interval (CI): 0.52–0.64; р = 0.007) and the tumour distance from the distal margin to the dentate line (AUC = 0.63; 95% CI: 0.53–0.64; p = 0.0009). In the structure of comorbidity, a significantly high probability of treatment complications was detected in patients with diabetes mellitus (RR = 4.05; 95% CI: 3.16–5.20; p < 0.0001), obesity (RR = 3.11; 95% CI: 2.52–3.83; p < 0.0001), varicose veins of the lower extremities (RR = 1.81; 95% CI: 1.36–2.41; p < 0.0001).

CONCLUSION: the available statistically confirmed data on the prognostic potential of each analyzed indicator can be used in the future to compile an algorithm for the formation of risk groups even before the start of antitumor treatment of rectal cancer.

AIM: to optimize patient selection criteria for the laparoscopic left hemicolectomy with transanal specimen extraction (TES).

PATIENTS AND METHODS: the treatment outcomes of 68 patients who underwent surgery for left-sided colon tumours between October 2022 and August 2024 were analyzed. Transanal extraction of the specimen (TES) was successfully performed in 42 (62%) cases (TES group), while 26 (38%) patients required a minilaparotomy (minilaparatomy group — ML). In addition to assessing early postoperative outcomes, intraoperative specimen circumference was measured in all patients, and the sensitivity and specificity of the patient selection criteria according to the Consensus were analyzed.

RESULTS: in the successful TES group, in addition to the excellent cosmetic effect due to the absence of an incision in the anterior abdominal wall, several advantages were also identified, such as a pain reduction already within the first day of the postoperative period — 3 (2; 4.3) points in the TES group compared to 5 (4; 6) points in the ML group (p < 0.001) with a significant decrease in the complication rate: 3/42 (7%) cases in the TES group versus 8/26 (31%) in the ML group (p = 0.0003). The circumference of the specimen in the TES group was 11.7 (2.6) cm, while in the ML group it was 16.2 (2.1) cm (p < 0.0001). The threshold value of this parameter for successful TES, based on ROC-analysis, was 16 cm. The diagnostic value of the Consensus criteria in predicting the successful performance of TES showed that their relative risk (RR) was 2.3 (95% CI: 1.2–5.1); p = 0.004; sensitivity — 88.1% (95% CI: 75-94.8); specificity — 42.3% (95% CI: 25.5-61.1). Adding another parameter (intraoperative circumference of the specimen) to the Consensus criteria significantly increased the diagnostic value: RR = 3.1 (95% CI: 1.8–6.2); p < 0.0001; sensitivity = 83.3% (95% CI: 69.4-91.7); specificity = 73.1% (95% CI: 53.9-86.3).

CONCLUSION: laparoscopic left hemicolectomy with transanal specimen extraction demonstrates superior early postoperative outcomes compared to laparoscopy-assisted procedures with minilaparotomy. Adding intraoperative specimen circumference to the Consensus criteria for TES patient selection significantly improves their accuracy.

The paper presents a clinical case of successful treatment of a gastrointestinal tumor in a patient who had previously undergone proctocolectomy for complicated ulcerative colitis.

AIM: to present clinical case of complicated cecal lipoma.

PATIENTS AND METHODS: patient K., 62 years old, with one and a half years with a diagnosis of ascending colon lipoma with bloating, abdominal pain, was hospitalized in the coloproctology unit in an emergency with a diagnosis of partial intestinal obstruction. When analyzing the data of RCT of OBP, there was a suspicion of intussusception of the right colon, and a decision was made on surgical treatment. Laparoscopic right hemicolectomy was done.

RESULTS: colon lipomas are benign tumors that are asymptomatic, are mostly random findings during video colonoscopy, and do not require treatment. But an increase in the size of the tumor can lead to the development of complications for which surgical treatment is used.

CONCLUSION: the authors present a clinical case of a 62-year — old female patient with cecal lipoma complicated by colon intussusception, which required surgical correction.

AIM: to analyze, based on literature data, a clinical case of total necrotizing obstructive enterocolitis in a patient with CO.

CLINICAL CASE: a stable patient with no comorbidities developed septic shock within hours following tumor stenting for CO. The underlying cause was ischemia of both the small and large intestines. The patient required subtotal colectomy and prolonged treatment in the intensive care unit to achieve recovery.

CONCLUSION: colon ischemia in the context of CO remains an under-researched condition, with undefined diagnostic criteria and a high postoperative mortality rate. This issue warrants close attention and broader discussion within the medical community.