R. G. Avanesyan

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.

The results of treatment of gastroduodenal bleedings in the Russian Federation leave much to be desired. According to the chief surgeon and endoscopist of the Russian Federation, Academician A. Sh. Ramishvili [2], operative mortality in the treatment of gastroduodenal bleedings is 19 %, and only in 32 % of cases, bleeding was stopped endoscopically. The article analyzes the problems in the treatment of gastroduodenal bleedings. The main problem is organizational. Strict implementation of national clinical recommendations by surgeons and endoscopists is necessary for high-quality care for patients with gastroduodenal bleedings (1). Special conditions should be created in hospitals to help patients with gastroduodenal bleedings. These are the presence of a surgical team, intensive care unit, blood transfusion department or cabinet, 24-hour endoscopy (department or cabinet) equipped with modern digital endoscopes and all the tools to stop bleedings. It is necessary to treat not the bleeding but the patient with bleeding. For this purpose, it is necessary to use drug antisecretory therapy after endoscopic treatment. It is very important that surgeons and endoscopists equally understand the complexity of the problem – the treatment of gastroduodenal bleedings.

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.

Objective. To improve the outcomes of percutaneous endobiliary interventions through prediction of postoperative complications and searching for minimally invasive methods of their treatment. Material and methods. Percutaneous en dobiliary interventions have been performed in 2458 patients for the period from 2006 to 2018 including bile duct stenting in 1895 patients. Results. Early postoperative complications included hemobilia (2.1%), abdominal bleeding (0.2%), duodenal bleeding (0.1%), pleuritis (0.9%), abdominal bile leakage (1.5%) and peritonitis (0.8%), liver hematoma (0.7%), right-sided pleuritis (0.9%), pancreatitis (13.8%). In our opinion, these complications are serious and require immediate intensive care and invasive repair. Mortality rate was 8.4% among all patients with early complications and 0.9% among those after endobiliary interventions. Delayed complications of percutaneous transhepatic interventions are migration of stent or drainage tube, drain incrustation, malignant invasion of stent, recurrent cholangitis, cholangiogenic liver abscesses, abdominal abscesses, sepsis, fragmentation of drain or stent, portal vein thrombosis. The most severe late complications (sepsis and portal vein thrombosis) resulted mortality rate 50–60%. Conclusion. Combined dual (ante- and retrograde) biliary approach and control throughout minimally invasive surgery eliminate disadvantages of individual accesses, reduce invasiveness, postoperative morbidity and mortality.