AIM: to establish the consensus on controversial issues of the surgery for Сrohn’s disease by Delphi method.METHODS: a cross-sectional study was conducted by the Delphi method. 62 experts voted intramural and anonymous (31.03.23). 5 statements from the current edition of clinical guidelines were selected for correction by working group and further voting [2]. Based on the practical experience of the working group and literature data, 3 new statements were created also. Statements that do not reach the required level of agreement (80% or more) will be subjected to Round 2 of the Delphi method.RESULTS: all experts took part in the anonymous voting. The panel of experts is represented by 8 different areas of practical medicine and the median of the professional experience of the respondents was 30 (12–49) years. Of the 8 statements submitted for voting, consensus (80% or more) was reached on 6 out of 8. 2 statements have been revised by working group for the distance 2nd round of the Delphi study. Consensus (more than 80%) was reached on both.CONCLUSION: a cross-sectional study by the Delphi method provided the opinions of a panel of experts on controversial issues in the surgical treatment of Crohn’s disease. Statements that reach consensus will be included by the working group in a new edition of clinical guidelines of Crohn’s disease.

AIM: to identify predictors of colectomy in patients with «extremely severe» ulcerative colitis.PATIENTS AND METHODS: seventy-four patients with severe ulcerative colitis in 2017 were included in the study. The patients were divided into the groups of colectomy (54 pts) and conservative treatment (20 pts).The predictors such as serum albumin, C-reactive protein, hemoglobin, endoscopic picture, and clinical data were analyzed.RESULTS: the groups were homogeneous by gender, age and duration of the disease. Mean albumin and hemoglobin levels were significantly lower (28 g/l and 96 g/l) in the colectomy group.The endoscopic picture of «extensive ulcer defects merging among themselves» was significantly more common in the operated patients – 78%, compared with 5% in the conservative treatment group (p<0.0001). The risk of colectomy in the presence of an endoscopic picture was 85%, and when combined with an albumin level of less than 31 g/l and hemoglobin of less than 107 g/l, the risk increased to 100%.CONCLUSION: the endoscopic picture of «extensive, merging ulcerative defects» in combination with an albumin level of less than 31 g/l and hemoglobin less than 107 g/l are predictors of colectomy with high predictive value.

AIM: to improve the results of treatment of patients with «extremely severe» ulcerative colitis (UC).PATIENTS AND METHODS: A multicenter observational prospective «case-control» study was conducted. The study included 71 patients with «extremely» severe UC from June 2019 to October 2021. All patients underwent conservative therapy in accordance with current clinical guidelines. Evaluation of the effectiveness of treatment was carried out on the 3rd and 7th days of therapy, a "response" or "no response" to steroid therapy was stated.RESULTS: A total of 48 (68%) patients underwent surgical treatment during the follow-up period during hospitalization. 23 (32%) patients "responded" to conservative therapy and were discharged without colectomy. A reliable independent predictor of colectomy at the time of hospitalization was the level of albumin less than 29 g/l (OR – 8,6 95% CI: 2,5 – 39,9, p=0,002). On day 3, the reliable predictors were the level of C-reactive protein over 15.5 mg/l (OR – 9 95% CI: 2.4 – 46.1, p=0.003) and the value of the Mayo index above 7 points (OR – 13.3 95% CI: 3.3 – 75.7, p=0.0009).CONCLUSION: The study has demonstrated that the only reliable and independent predictor of colectomy at admission to the clinic is the level of albumin less than 29 g/l. Reliable factors that make it possible to evaluate and predict the effectiveness of therapy are the level of C-reactive protein more than 15.5 mg/l and the value of the Mayo index above 7 points on the 3rd day of therapy, as well as the level of C-reactive protein above 29 mg/l on the 7th day.

AIM: to identify risk factors for burnout of healthcare employees and to identify the most vulnerable category of practicing physicians.PATIENTS AND METHODS: an observational study based on a public survey started from June to August 2022. The validated Maslach Burnout Inventory questionnaire was used as a burnout assessment tool. An integral burnout index was calculated, on the basis of which significant risk factors were analyzed. The results obtained are presented in the form of a predictive nomogram.RESULTS: the high degree of emotional burnout in Russia among doctors reaches 32%. The most significant professional risk factors are relationships between colleagues (p = 0.0002), overtime work (p = 0.006), work in outpatient unit (p = 0.006), with severe patients (p = 0.008) and uneven planning of work activities (0.0004). The protective factors are: family (p = 0.001), sports (p = 0.001), meditation (p = 0.005) and talking about own problems (p = 0.01).CONCLUSION: burnout is a multifactorial problem. The proposed nomogram is useful for identification of the most vulnerable specialists.

AIM: to assess results of balloon dilatation (BD) and electric destruction (ED) for strictures of colorectal anastomoses.PATIENTS AND METHODS: the prospective cohort study included 69 patients with colorectal anastomotic strictures. Thirty-two of them underwent endoscopic balloon dilatation, 37 — electric destruction of scar tissue using a spherical monopolar electrode.RESULTS: the recurrence rate of the anastomotic stricture in the BD group was 3 times higher than after ED (OR = 2.9; 95% CI: 0.7–11.1; p = 0.04). The independent factor of stricture recurrence was the extent of stricture > 11 mm (OR = 11.8; 95% CI: 1,57–123,5; p = 0.02).CONCLUSION: electric destruction and balloon dilatation are effective and safe methods for strictures of colorectal anastomoses. The independent factor recurrence risk of the stricture was the extent of the scar narrowing more than 11 mm long.