Bleeding from the uppergastrointestinal tract is one of the most dangerous complications in patients with acute CVA (ischemic and/or hemorrhagic type). The combination of these conditions requires special attention in the diagnosis and choice of treatment methods. Central Nervous System pathology makes diagnosis, choosing methods oftreatment and the use of drug more complicated to surgeons in the postoperative period. With onset of hemorrhage, antithrombotic treatment should be canceled, that can negatively affect the results of treatment of patients with ischemic type of cerebral vascular accident. The use of anti-ulcer drugs, namely proton pump inhibitors, may increase the risk of hospital-acquired pneumonia,Clostridium difficileinfections, and cardiovascular diseases. These factors force us to consider issues related to diagnosis and treatment plans in this group of patients. The most promising direction in the treatment of patients with ischemic or hemorrhagic stroke in combination with gastroduodenal bleeding is the identification of risk factors for upper gastrointestinal bleeding, early endoscopic diagnosis and treatment, performing preventive treatment. The article presents a brief review of domestic and foreign literature, some issues of etiology and pathogenesis of gastroduodenal bleeding in patients with cancer, the results of our own research, capabilities of modern endoscopy in the diagnosis and treatment of gastrointestinal bleeding in this group of patients. The algorithm of management of patients with a combination of bleeding from the upper gastrointestinal tract and CNS pathologies.

РАЗЛИЧНЫЕ ЭНДОСКОПИЧЕСКИЕ МЕТОДЫ ЛЕЧЕНИЯ АХАЛАЗИИ КАРДИИГородская Мариинская больница, Российская Федерация, 194104, Санкт-Петербург, Литейный пр., 56 В статье представлен оптимальный алгоритм обследования больных с подозрением на аха-лазию кардии. Для установления диагноза использовали рентгенологический метод исследо-вания, МСКТ органов грудной клетки, верхнего этажа брюшной полости и эндоскопический метод исследования. Все используемые методы позволяют своевременно и правильно устано-вить диагноз и стадию развития заболевания. При стадировании заболевания использована классификация, предложенная Б. В. Петровским (1962 г.). Рассмотрены результаты лечения ахалазии кардии посредством эндоскопической баллонной дилатации, направленной на рас-ширение нижнего пищеводного сфинктера, введение ботулинического токсина, что способ-ствует снижению тонуса кардии, малоинвазивные эндоскопические методики в сочетании с медикаментозной терапией, а также хирургическое лечение больных с IV стадией заболе-вания, которое позволяет получить хороший и удовлетворительный клинический результат лечения у 98,2 % больных. Также в статье представлен совершенно новый в Российской Фе-дерации эндоскопический метод лечения ахалазии кардии -пероральная эндоскопическая миотомия (POEM, peroral esophageal myotomy In this article, we showed the optimal examination schedule in patients with suspected achalasia. Th e diagnostic algorithm of achalasia included X-ray, multispiral computed tomography (MSCT) of the chest and upper abdomen and endoscopic examination methods. All these methods allowed for establishing the exact diagnosis and precise stage of the disease. Th e most common classifi cation for achalasia staging in the Russian Federation is the classifi cation proposed by Petrovskiy B. V. in 1962 which is based on the interpretation of X-ray imaging results because of their simplicity and availability. In this study we also showed diff erent treatment options such as an endoscopic balloon pneumatic dilation used to relieve the obstruction by mechanical disrupting, botulinum toxin injection directed to reduce pressure of the lower esophageal sphincter, minimally invasive interventions with pharmacological therapy, and surgical treatment for patients with IV stage of the disease that may benefi t in 98,2% of those patients. Additionally we showed clinical results of an absolutely new treatment method of endoscopic managing achalasia in the Russian Federation: oral esophageal myotomy (POEM) used in our clinic since 2014. It is a promising and minimally invasive option for treating achalasia. However, it still requires more data and assessment of clinical effi cacy. Refs 19. Figs 8. Keywords: Achalasia, endoscopic balloon pneumatic dilation, botulinum toxin injection, peroral endoscopic myotomy (POEM). ВведениеВ структуре хирургических заболеваний пищевода ахалазия кардии занима-ет 3-е место после онкологических заболеваний и рубцовых стриктур, составляя 3,1-20 % всех заболеваний пищевода [4].