Aim: to examine current evidence on the key metabolic alterations that reflect the major pathogenetic axes of metabolic syndrome (MS) and to assess their potential for the diagnosis and stratification of MS.

Key points. The review highlights five major metabolomic pathogenetic axes of MS: anabolic resistance, mitochondrial dysfunction, systemic inflammation, insulin resistance, and lysosomal insufficiency. Each represents an essential pathogenic link influencing the development of MS complications. Characteristic alterations of low-molecular-weight metabolites (such as amino acids and organic acids) and lipids identified through modern metabolomic analytical methods are described for each axis, and their clinical significance is discussed. Special attention is given to the role of combined metabolite panels, which improve early diagnosis of MS and prediabetes, allow risk stratification for complications (type 2 diabetes, atherosclerosis, nonalcoholic fatty liver disease, etc.), and enable monitoring of treatment effectiveness. It is noted that metabolomic biomarkers possess high diagnostic and prognostic value, complementing standard clinical indicators. Evidence is presented showing that integrating metabolomic data with clinical parameters increases diagnostic accuracy (for example, combining metabolomic markers with the glucose tolerance test improves its predictive value). The development of integrated metabolomic indices (such as MetSCORE) provides high accuracy in identifying MS (AUROC ~0.9). Metabolomic studies confirm the heterogeneity of MS and allow subclassification according to predominant pathophysiological disturbances, opening prospects for precision medicine.

Conclusion. Thus, the metabolomic approach substantially expands the possibilities for diagnosis and personalized therapy in patients with MS. It enables the detection of latent metabolic disturbances at the preclinical stage of disease, complementing routine diagnostic methods. Implementation into clinical practice requires standardization of metabolomic analytical protocols, validation of metabolomic biomarkers, and integration of multi-omics approaches, which will ensure the reproducibility of results and their broad application in medicine.

Aim. Review of current achievements, opportunities and challenges in applying artificial intelligence (AI) for analyzing intestinal ultrasound images.

Key points. Ultrasound examination is a highly informative, safe, and widely accessible method for bowel pathology diagnosis. The integration of AI, particularly deep learning and radiomics methods, aims to overcome the operator-dependence of ultrasound, standardize diagnosis, and enhance its efficiency. This article reviews the development and validation of AI algorithms for key areas: inflammatory bowel diseases, acute appendicitis, bowel intussusception and colorectal cancer. Limitations and concerns that require resolution for the successful integration of AI into clinical practice are also discussed.

Conclusion. The integration of AI into ultrasound diagnosis of bowel diseases has significant potency for improving accuracy, reproducibility, and operational efficiency.

Pancreaticoduodenectomy (PDR) is the primary surgical treatment for periampullary malignancies. Late complications after PDR occur in 31.5 % of cases. The most serious of these are biliary anastomotic strictures and bile duct stone formation (biliary complications), which can occur in up to 10.2 %.

Aim: to analyze the literature concerning the causes of biliary complications, particularly stone formation in the bile ducts after PDR, and the treatment methods for these patients.

Key points. Predisposing factors for stone formation after PDR include bile stasis (due to anastomotic stricture), remnants of suture material or clips, infection, and reflux of intestinal contents into the bile ducts. The choice of a minimally invasive treatment method for patients with bile duct stones after PDR depends on the qualifications of specialists and the technical resources of the medical institution. The endoscopic approach is characterized by rapid clinical success and shorter hospitalization but has a lower technical success rate due to altered anatomy. Percutaneous access is a highly effective minimally invasive treatment for late biliary complications, which can be used as a firstline option or in cases where endoscopic intervention has failed. The use of absorbable suture material, minimizing the number of anastomotic sutures, various hepaticoplasty techniques, and avoiding excessive bile duct mobilization may help prevent stone formation after pancreaticoduodenectomy.

Conclusion. Bile duct stones as a complication of the late postoperative period of PDR require highly qualified surgical care, including minimally invasive techniques. Further research is needed to identify possible ways to prevent and improve treatment methods for biliary complications of postpartum biliary reflux.

Aim: to develop neural network predictive model for the risk of postoperative complications and mortality in patients with liver cirrhosis undergoing minimally invasive surgical interventions.

Material and methods. Surgical interventions were performed on 90 patients with liver cirrhosis to correct complications of portal hypertension (ligation of esophageal varices (n = 57), transjugular intrahepatic portosystemic shunting (n = 6)) and for surgical treatment of comorbid conditions (n = 30). Two operations were performed on three patients during a single hospitalization. Mortality was 2.2 %, and postoperative complications were identified in 16 (17.8 %) individuals. For all patients, internationally recognized scales developed for patients with liver cirrhosis were calculated and included in the predictive model: Child — Turcotte — Pugh, MELD, Mayo Postoperative Surgical Risk Score, and VOCAL-Penn. Using automated neural networks and the Data Mining package in Statistica, comprehensive models for predicting surgical complications and mortality were developed.

Results. Comprehensive predictive models were created, incorporating the assessment of clinical, biochemical parameters, and quality of life indicators, which possess high predictive value. Based on these models, two calculators were proposed for calculating the risk of postoperative complications and mortality in patients with liver cirrhosis.

Conclusion. The integration of minimally invasive technologies for correcting complications of portal hypertension and predictive models developed through machine learning opens new possibilities for improving the outcomes of surgical interventions in patients with liver cirrhosis.

Aim: to evaluate the clinical success and complication rates of endoscopic step-up necrosectomy in patients with infected walled-off pancreatic necrosis, based on an analysis of contemporary scientific publications.

Material and methods. A systematic review and meta-analysis of 15 studies (total of 869 patients) published since 2020 and conforming to current treatment standards was conducted. The inclusion criteria were peer-reviewed original articles in Russian or English focusing on endoscopic step-up necrosectomy via a transluminally placed metal stent with a diameter greater than 1 cm in patients with confirmed infected walled-off pancreatic necrosis. A random-effects model was used for meta-analysis.

Results. The weighted mean clinical success rate of endoscopic step-up necrosectomy was 89.5 % (95% confidence interval (CI): 87.5–92.1 %). Considerable variability in outcomes was observed between studies (range: 61 to100%), with significant heterogeneity (I2= 89.2 %). The mean complication rate was 18.8 % (95% CI: 12.5–25.1%).The most frequent complications were stent migration (5.2 %), bleeding (3.9 %), and stent obstruction (2.1 %). The analysis revealed significant variability in the criteria used to define clinical success across the studies.

Conclusions. Endoscopic step-up necrosectomy is a highly effective treatment for infected walled-off pancreatic necrosis with an acceptable safety profile. However, the lack of unified, standardized criteria for clinical success and the high heterogeneity of the data complicate comparative analysis. To improve the quality of evidence, it is necessary to develop standardized definitions of success and complications, as well as to conduct randomized controlled trials.

Aim: to investigate the frequency of gene polymorphisms related to coagulation, the folate cycle, platelet receptors, serine protease inhibitor clade E member 1 (SERPINE1), selectin P ligand (SELPLG), and Janus kinase 2 (JAK2) in patients with pediatric-onset portal vein thrombosis (PVT).

Materials and methods. A cross-sectional study was conducted, including patients with pediatric-onset non-cirrhotic PVT (n = 31), all of European ancestry. Polymerase chain reaction was used to genotype the following polymorphisms: F2 (rs1799963), F5 (rs6025), FGB (fibrinogen beta chain) (rs1800790), ITGA2 (integrin subunit alpha 2) (rs1126643), ITGB3 (integrin subunit beta 3) (rs5918), MTHFR (methylenetetrahydrofolate reductase) (rs1801133), SERPINE1 (rs1799889), SELPLG (rs2228315), and JAK2 (rs77375493). A history of local risk factors for PVT in the early neonatal period was noted in 12 (39 %) patients, including omphalitis, umbilical sepsis, and umbilical vein catheterization.

Results. Mutations in the F2 (rs1799963) and F5 (rs6025) genes were identified in two patients. The A allele of the FGB gene (rs1800790) was found with a frequency of 21 %, the T allele of the ITGA2 gene (rs1126643) with a frequency of 37.1 %, and the T allele of the MTHFR gene (rs1801133) with a frequency of 32.3 %. The 4G polymorphism in the SERPINE1 gene (rs1799889) was the most frequent: it was found in the homozygous form in 18 (58 %) patients and in the heterozygous form in 9 (29 %) patients; the frequency of the 4G allele was 72.6 %. The somatic JAK2 mutation (rs77375493) was not detected in any of the patients. The presence of either a mutation in the F2 or F5 genes, or homozygous variants for the other studied polymorphisms, was identified in 24 (77 %) patients. A single genetic risk factor was present in 15 (48 %) patients, two factors — in 6 (19 %) patients, and three factors — in 3 (10 %) patients. No significant differences in the frequency of individual polymorphisms were found between patients with and without local risk factors. However, the combination of the A allele of the FGB gene and the C allele of the ITGB3 gene was observed significantly more frequently in patients with local risk factors compared to those without (33 % vs. 5 %; p = 0.039).

Conclusion. In a small Russian cohort of patients with pediatric-onset PVT, well-known thrombophilic mutations in the F2 and F5 genes were identified. Also, polymorphisms in SERPINE1, MTHFR, FGB, ITGA2, ITGB3, and SELPLG genes were identified, which potentially contribute to an increased risk of thrombosis.

Aim: to assess bone mineral density (BMD) in children with inflammatory bowel diseases (IBD) and analyse the factors influencing it.

Materials and methods. The study included 113 patients with IBD (58 with Crohn’s disease and 55 with ulcerative colitis) and 61 healthy children (control group). All the participants had a comprehensive assessment of BMD by means of dual-energy X-ray absorptiometry (DEXA), as well as measurement of vitamin D levels, biochemical markers of bone metabolism, dietary calcium intake, and physical activity.

Results. Decreased BMD of varying degrees was identified in 39.8 % of patients with IBD, which is substantially more frequent than in the control group (p = 0.001). Significant predictors of decreased BMD were established: disease duration exceeding 3 years, high clinical and endoscopic activity, low calcium intake (Ме) 300 mg/day vs 550 mg/day in the control group (р < 0.001), and dose-dependent effect of glucocorticoid therapy.

Conclusion. Low bone mass build-up in children with IBD is a multifactorial process associated with disease activity and duration, dietary restrictions, and treatment modalities, underscoring the need for multidisciplinary monitoring of bone tissue status in this patient group.

Background. The use of phlebotonics in the postoperative period after hemorrhoidectomy has already proven effective in preventing postoperative complications. However, the initiation of phlebotonics in the preoperative period is covered in only a few publications in modern literature.

Aim: to evaluate the effect of phlebotonics on the postoperative course after open hemorrhoidectomy for stage II–IV haemorrhoidal disease when used both before and after surgery.

Material and methods. The study was a randomized controlled trial and included 60 patients with stage III–IV haemorrhoidal disease: in the main group (n = 30), phlebotonics (hesperidin 100 mg + diosmin 900 mg, Venarus®) were started 10 days before surgery at a dosage of 1000 mg once daily and continued after surgery according to the scheme: 1000 mg twice daily on days 1–7, then 1000 mg once daily on days 8–14; in the control group (n = 30), phlebotonics were started only after surgery and administered according to the protocol for acute hemorrhoids. The primary endpoint was the frequency of edema and thrombosis of the mucocutaneous bridges by day 14 after surgery. Secondary endpoints were pain intensity according to VAS, the presence of postoperative bleeding, the patient's quality of life according to the validated SF-36 questionnaire, the speed of postoperative wound healing, and the time to return to daily physical activity.

Results. The groups were comparable in terms of baseline characteristics; no significant differences in age, sex, BMI, disease stage, or main clinical manifestations of haemorrhoidal disease were recorded. Edema of the mucocutaneous bridges in the main group by day 21 after surgery was significantly lower compared to the control group (p = 0.05). No significant differences in bleeding between days 1 and 7 postoperatively were noted between the groups; however, a statistically significant reduction in discharge in the main group was observed in the second and third weeks after surgery (p = 0.03 and p = 0.02, respectively). The intensity of pain, starting from the first day and throughout the three weeks after surgery, was significantly lower in the main group (p ≤ 0.05). Patients in the main group had a faster return to daily physical activity and significantly faster healing of postoperative wounds, confirmed by the SF-36 questionnaire results in terms of social functioning, mental health, physical functioning, and general health (p = 0.05). On day 60 after surgery, residual perianal skin tags causing hygiene issues and discomfort were found in only 2 (7 %) patients of the first main group and 5 patients (17 %) of the second group (p = 0.4).

Conclusions. The use of phlebotonics in patients before and after open hemorrhoidectomy, compared to use only in the postoperative period, demonstrates statistically significant efficacy in preventing the development of edema of the mucocutaneous bridges and reducing pain syndrome.

Aim: to analyze complications arising from coloproctological surgeries using a 1940 nm wavelength laser, identify their causes, and propose preventive measures.

Materials and methods. 148 patients with stage 2–3 hemorrhoids underwent transdermal laser submucosal destruction of internal hemorrhoids using a diode-pumped fiber laser with a wavelength of 1940 nm and a power of 7.5 W in a pulsed-periodic mode (pulse — 500 ms, pause — 750 ms).

Results. Intraoperatively, bleeding from the internal hemorrhoid developed in 4.4 % (3/148) of patients. The cause was its trauma with a laser instrument and a violation of the integrity of the mucous membrane of the internal hemorrhoid. In this regard, hemorrhoidectomy was performed. The occurrence of intraoperative hematoma was diagnosed in 10.1 % (15/148) of patients and regarded as a complication. In all cases, the submucous hematoma was characterized by small sizes (3.0–4.0 cm) and did not increase during observation for 5–10 minutes. In the early postoperative period (on the first day after surgery), thrombosis of external hemorrhoids developed in 5.4 % (8/148) of patients, which regressed completely with conservative treatment. In the early postoperative period, 0.7 % (1/148) of patients were diagnosed with the development of an ulcerative mucosal defect in the area of the internal hemorrhoid, which healed with conservative therapy. According to our analysis, the main causes of complications are incorrect surgical technique and excessive laser energy exposure.

Conclusion. Laser methods are promising for minimally invasive treatment of anorectal diseases but require strict adherence to surgical techniques and control of energy parameters. Optimizing methodology and standardizing approaches will help reduce the frequency of complications and improve treatment safety.

Aim: to highlight the diagnostic challenges of Alagille syndrome (AGS), which can mimic other cholestatic diseases like biliary atresia. We aim to emphasize the importance of integrative diagnostic approaches, including genetic testing, to avoid misdiagnosis and unnecessary surgical procedures in cases where histological findings, such as ductular proliferation, do not follow typical patterns of AGS.

Key points. Diagnosing Alagille syndrome AGS is quite complex as it shares symptoms similar to those of other cholestatic diseases, especially biliary atresia. Bile duct paucity is the major pattern of AGS. Infants more than six months of age usually already show a visible bile duct paucity. However, in this case, our patient, who was more than six months old, didn’t show bile duct paucity and ductular reaction was the major pattern. A four-year-old girl presented with chronic cholestasis, congenital heart disease, skeletal anomalies, ocular abnormalities, and facial deformity. Her liver biopsy at the age of one year predominantly showed ductular proliferation. Initially, we diagnosed her with biliary atresia. However, subsequent examination of a total hepatectomy sample at the age of four revealed bile ducts were difficult to identify in most portal tracts. Genetic testing in 2022 identified a heterozygous likely pathogenic variant in the JAG1 gene, confirming AGS. The patient underwent liver transplantation.

Conclusion. We report the histology findings in AGS that can potentially be mistaken for other cholestatic diseases. We also highlight the importance of integrative diagnostic approaches to avoid misdiagnosis and unwarranted surgical procedures.

Aim: to present clinical guidelines describing the clinical, laboratory, endoscopic and histological characteristics of autoimmune gastritis (AIG) and to provide information support for decision-making on diagnosis, prognosis assessment and choice of management tactics for patients with AIG.

Key points. AIG is an organ-specific autoimmune disease characterized by the presence of antibodies to parietal cells and/or intrinsic factor, in which inflammation and atrophy are limited to the gastric mucosa, functionally manifesting as hypo- and achlorhydria. There is evidence of an increase in the incidence of AIG worldwide. AIG is often associated with autoimmune thyroiditis (up to 40 % of cases), type 1 diabetes mellitus, and autoimmune polyglandular syndrome. Data on laboratory diagnostic methods, esophagogastroduodenoscopy, and histological examination of biopsies are presented, with an analysis of the endoscopic and histological picture typical of AIG. When AIG is combined with H. pylori infection, eradication therapy is recommended. In addition to symptomatic treatment and treatment of anemia, long-term rebamipide therapy is recommended to potentiate the protective properties of the gastric mucosa. Endoscopic monitoring of patients with AIG is recommended at intervals of once every 3 years.