HEPATOLOGY and GASTROENTEROLOGY

SOME OF STUDY RESULTS FOR HEPATITIS B VACCINATION EFFECTIVENESS IN THE REPUBLIC OF BELARUS

V. S. Vysotskaya — 2025-06-20

Background. Viral hepatitis, including that caused by hepatitis B virus (HBV), is a significant public health problem of the current decade, and the world is still far from achieving its elimination by 2030. Objective. To investigate the prevalence of HBV markers and evaluate the effectiveness of vaccination in certain population groups. Material and methods. HBsAg, antibodies to surface antigen (anti-HBs) allowing to assess the protective immune response to HBV, and total antibodies to HB-core antigen of HBV (anti-HBc) as an indirect marker of the patient's contact with HBV were tested. The seroprotective concentration of specific antibodies in serum was considered to be 10 mIU/mL and higher (ELISA, test systems produced by Vector-Best JSC (Russian Federation). Prophylactic hepatitis B vaccination coverage (documented vaccination) was assessed by collecting and analyzing data on the availability of a full course of vaccination at primary health care level according to the data from primary medical documentation forms No. 063/u “Card of prophylactic vaccinations”, No. 064/u “Journal of prophylactic vaccination records”, and electronic databases of prophylactic vaccination records. Results. A full course of HBV vaccination ensures the formation of protective immunity in 68.35% of the examined individuals. The proportion of seropositive individuals decreases with the passing of time after completion of vaccination. The results of the study demonstrate the presence of 34.68% of seronegative subjects 15 or more years after the last dose of HBV vaccine. A survey of 1365 individuals identified 213 individuals – 15.65% (95% CI 13.77-17.63) – having anti-HBc. Conclusion. In order to achieve the targets of the Global Health Sector Strategy for elimination of viral hepatitis by 2030, it is necessary to focus both on vaccination organizational aspects within the framework of the National Immunization Schedule and on the implementing serological testing for at-risk populations with subsequent optimization of vaccination strategies.

APPLICATION OF RISK ANALYSIS METHODOLOGY IN EPIDEMIOLOGICAL AUDITS IN ENDOSCOPY (Report 1)

N. D. Kolomiets — 2025-06-20

Background. Since endoscopy introduction in the last century the number and significance of endoscopic procedures have substantially increased globally. Concurrently, there has grown the risk of healthcare-associated infections (HAIs) during endoscopic procedures particularly due to equipment failures, breaches in endoscope reprocessing, and noncompliance with established guidelines. Objective. To develop a standardized checklist for epidemiological audits in endoscopy departments/units, based on the risk analysis methodology. Material and methods. The study employed a risk assessment and prioritization framework (WHO, 2021) as its core methodology. Results. A qualitative four-level risk grading scale, marked using a “traffic light” system, was designed and integrated into the checklist. The checklist covered two audit domains: (1) “General Training of Medical Staff” (13 items) and (2) “Assessment of Infrastructure, Equipment, and Technological Processes in Endoscopy Units” (23 items). The developed tool was piloted in nine endoscopy departments across healthcare facilities in the Republic of Belarus. In the first domain, 58 total non-conformities were identified: 47 (81%) classified as Categories A and B, 10 (17%) as Category C, and 1 as Category D. In the second domain, 87 non-conformities were documented: 62 (71%) in Categories A and B, 12 (14%) in Category C, and 13 (15%) in Category D. These findings suggest that a significant proportion of non-conformities remain undetected in routine practice, potentially leading to serious complications and systemic failures over time. Conclusion. The integration of a systematic risk assessment approach through the use of standardized checklists and Standard Operating Procedures (SOPs) creates a synergistic effect that enhances risk management processes. This strategy contributes to improved safety and quality in endoscopy-related healthcare delivery.

ANALYSIS OF CASES OF ACUTE ON CHRONIC LIVER FAILURE IN PATIENTS WITH CIRRHOSIS IN 2023-2024

N. M. Silivontchik — 2025-06-20

Background. Acute-on-chronic liver failure (ACLF) is a severe form of acute decompensation of liver cirrhosis associated with high mortality. Objective. To assess the incidence, severity, precipitating factors and outcomes of ACLF in patients with cerebral palsy admitted to the inpatient department of the city hospital. Material and methods. The study included 283 patients during 347 episodes of hospitalization to the gastroenterology and intensive care units of the 2nd Minsk City Clinical Hospital in 2023-2024. Results. ACLF was diagnosed during 111 episodes of hospitalization, accounting for 53.6% (95% CI 46,8-60,4) of acute decompensation (n=207) and 32.0% (95% CI 27,1-36,9) of all hospitalization episodes (n=347) in patients with cirrhosis. ACLF-1 was noted in 35 of 111 patients, including ACLF-1a in 10, ACLF-1b in 25, ACLF-2 in 29 and ACLF-3 in 47. Of the 111 patients with ACLF, 61 died (55,0%), including 35 (57,4%) without a history of liver cirrhosis: 7 of 35 (20%) died with ACLF-1, 13 of 29 (45%) with ACLF-2, 41 of 47 (87%) with ACLF-3, including 16 of 22 with ACLF 3a, and all 25 with ACLF-3b. Of the number of deceased patients (n=61), bacterial infections were established in 53 (87%). Conclusion. Analysis of ACLF cases allows us to demonstrate the importance of understanding the meaning, content and mechanisms of ACLF as well as the challenging task it poses on healthcare institutions in managing patients with this complex pathology and high risk of adverse outcome.

EVALUATION OF MESENCHYMAL STEM CELLS SYSTEMIC APPLICATION EFFECT ON LIVER TRANSPLANT FUNCTION RECOVERY IN THE EARLY POSTOPERATIVE PERIOD

S. V. Korotkov — 2025-06-20

Background. Liver transplantation is the only radical method of treating of terminal stages of liver failure in cirrhosis. However, despite the progress of surgical techniques and immunosuppression protocols with calcineurin inhibitors application, the incidence of immunological complications is above 40%, which significantly affects the rerecovery of transplant function in the early postoperative period. Objective – to evaluate the effect of systemic of mesenchymal stem cells (MSCs) application on the liver transplant function recovery in the early postoperative period. Material and methods. Randomized prospective study in 30 patients after liver transplantation was performed. The main group (n=15) received systemic MSC therapy, the control group (n=15) – standard immunosuppressive therapy. MSCs were infused intravenously twice: intraoperatively and on the 4th day after surgery at a dose of 2×106 cells per kg. Biochemical parameters of liver function, inflammation markers, results of morphological and immunohistochemical examination of the graft, Tacrolimus concentration, and incidence of complications were assessed. Results. In the MSC group, graft function recoved faster: on the 10th day, the ALT level was 78 versus 98 U/L, bilirubin - 34 versus 53 μmol/L (p<0.05). The frequency of acute cellular rejection was lower in the MSC group (20% versus 33%). Matrix Metalloproteinase-10 (MMP-10) expression in the graft was also lower in the main group (15% versus 20%, p=0.046). MSCs application allowed to maintaining lower concentrations of Tacrolimus (3.1 versus 4.7 ng/ml on the 7th day, p<0.05) without increasing the frequency of rejection. Levels of inflammatory markers were lower in MSCs application: CRP (34 versus 55.5 mg/L) and procalcitonin (0.9 versus 3.79 ng/ml) on the 7th day (p<0.05). There were no complications associated with the administration of MSCs. Conclusion. Systemic application of MSCs is safe and effective method of immunosuppressive therapy after liver transplantation, which accelerates the reсovery of liver transplant function after operation, reduces the risk of acute rejection and allows to minimize the doses of calcineurin inhibitors.

PREDICTING THE PROBABILITY OF REGIONAL LYMPH NODE METASTASES IN GASTRIC CANCER ACCORDING TO CLINICAL DATA

M. Yu. Reutovich — 2025-06-20

Background. Limited diagnostic accuracy of traditional preoperative imaging techniques for gastric cancer N-staging leads to inappropriate treatment planning. Hence the necessity to develop and apply prognostic models that allow for the prediction of metastatic lesions in regional lymph nodes. Objective. To develop a clinical data-based model for preoperative prediction of metastatic lesions in regional lymph nodes (pN+) in gastric cancer (GC). Material and methods. A retrospective analysis of radical treatment outcomes in 1054 patients with GC was performed. To develop a prognostic model based on linear logistic regression, the total patient sample was randomly divided into test and training cohorts. The model on the test sample included prognostic factors that demonstrated their discriminatory ability based on several selection algorithms. Clinical validation of the model was carried out according to the assessment of long-term treatment outcomes. Results. Risk factors for pN+ include: age – odds ratio (OR) is 1.02 (95% CI 1.0–1.04 per year), p=0.040; primary tumor size (natural logarithm) – OR is 1.8 (95% CI 1.4–2.4), p<0.001; infiltrative variant of macroscopic growth form – OR is 1.9 (95% CI 1.3–2.9), p=0.001; non-cohesive variant of adenocarcinoma – OR is 1.6 (95% CI 1.0–2.4), p=0.051; suspected metastatic lesions of regional lymph nodes according to preoperative assessment – OR is 4.0 (95% CI 2.6–6.2), p<0.001. There has been developed a prognostic model, concordance index (AUC for cohort tests) being 0.778 (95% CI 0.739–0.820). Conclusion. The application of the developed prognostic model with due regard to the clinical and morphological features of the neoplastic process, as well as patient's age allows for more accurate preoperative N-staging. This in turn contributes to optimizing management strategies for non-metastatic GC patients due to appropriate preoperative anti-cancer treatment planning.

SIMULTANEOUS LAPAROSCOPIC SPLENECTOMY AND CHOLECYSTECTOMY (a case study with a brief literature review)

E. V. Mahiliavets — 2025-06-23

Background. Simultaneous operations are a combination of several types of interventions during one laparoscopic procedure, with a good cosmetic result and rapid recovery after surgical aggression. Objective. Analysis of our own and available published outcomes of performing simultaneous laparoscopic splenectomy and cholecystectomy. Material and methods. The article presents a detailed description of our own experience of simultaneous laparoscopic splenectomy and cholecystectomy for a large posttraumatic splenic cyst and cholelithiasis. It also analyzes the available literature on the advantages and benefits of combined laparoscopic interventions. Results. The use of laparoscopic technologies allowed us to successfully perform simultaneous removal of the spleen and gallbladder during one surgical intervention. The postoperative period was uneventful. The patient was discharged for outpatient treatment. In the late postoperative period, she feels satisfactory. The data available in the scientific press confirm the effectiveness and safety of performing simultaneous combined laparoscopic interventions in patients with pathological changes in the spleen and gallbladder. Conclusion. The described clinical case alongside with the analyzed publications indicate that simultaneous operations for combined abdominal pathology are a feasible treatment option.

SURGICAL TREATMENT OF IATROGENIC BILE DUCT INJURY

K. S. Belyuk — 2025-06-23

Background. Surgical approaches for bile duct injury remain debated. There being no commonly accepted algorithm for iatrogenic bile duct injury, determination of optimal surgical treatment for this pathology is still a clinically relevant issue. Objective. To demonstrate the outcomes of surgical treatment of a patient with iatrogenic bile duct injury. Material and methods. The article presents our own experience of surgical treatment of a patient with iatrogenic bile duct injury, who underwent external-internal common bile duct prosthetics using a technique developed in the clinic. Results. The postoperative period passed without complications. Dynamic observation showed functional stability of the external-internal prosthesis with the flow of bile into the duodenum. The patient was discharged in satisfactory condition. Conclusion. External-internal prosthetics technique eliminates the disadvantages of traditional external biliary drainage and may be regarded as a method of choice for patients with iatrogenic bile duct injury.

A CASE OF HOLECYSTODUODENOCOLIC FISTULA IN A PATIENT SUFFERING FROM CHOLELITHIASIS, CHRONIC CALCULUS CHOLECYSTITIS, CHOLEDOCHOLITHIASIS

V. P. Strapko — 2025-06-23

Internal biliodigestive fistulas are quite rare and the most severe complications of cholelithiasis. A case of holecystoduodenocolic fistula in a patient suffering from cholelithiasis complicated by choledocholithiasis and obstructive jaundice is presented. During surgery, a dense infiltrate was detected in the subhepatic space, upon separation of which a holecystoduodenocolic fistula was diagnosed. The patient was operated on; cholecystectomy, separation of the holecystoduodenal and duodenocolic fistulas, choledocholithotomy, transduodenal papillophincterotomy, suturing of the fistula openings of the duodenum and transverse colon a well as choledochus drainage according to Vishnevsky being performed.

A RARE CASE OF LATE-DIAGNOSED GIANT PRIMARY MULTIPLE ANGIOMA OF THE SMALL INTESTINE MESENTERY AND LIVER

N. I. Prokopchik — 2025-06-23

Background. Angiomas are benign neoplasms made up of blood and lymphatic vessels and are found in various organs. Lymphangiomas of the abdominal cavity most often occur in the mesentery of the small intestine and are more common in children. Large mesenteric lymphangiomas in adults are a very rare pathology. Objective. To present a rare case of late diagnosed giant cavernous cystic lymphangioma of the mesentery of the small intestine alongside with hepatic hemangioma in an elderly woman who did not seek medical care for a long time. Material and methods. The clinical manifestations, laboratory and instrumental findings, as well as autopsy of a patient died due to viral-bacterial pneumonia (SARS-CoV-2 + bacterial infection, unspecified) were analyzed. During the examination of the patient, a large abdominal tumor of unclear genesis and unspecified origin was detected. After the autopsy, a pathohistological examination of the detected neoplasms of the mesentery of the small intestine and liver was performed, which made it possible to establish the diagnosis. Results. As a result of the autopsy, it was established that the patient, in addition to viral-bacterial pneumonia, had a giant cavernous cystic lymphangioma of the small intestine alongside with a hemangioma of the liver. The mass of the mesenteric tumor was 9350 g, the tumor size was 32.5 × 35.0 × 28.0 cm. The size of the hemangioma of the right liver lobe was 5 × 4 × 4 cm. Conclusion. Tumor progression, increased intra-abdominal pressure, compression of abdominal organs, high diaphragm position, as well as other factors contributed to the development and severe course of viral-bacterial pneumonia. The immediate cause of death was intoxication and progressive pulmonary-cardiac insufficiency.