Stanimir Kiurski

Endoscopy is a diagnostic technique used to visualize the interior of the gastrointestinal organs with the help of specially designed optical systems. In gastroenterology, upper endoscopy (esophagogastroduodenoscopy) and colonoscopy represent the most commonly used procedures for evaluating the gastrointestinal tract. Successful endoscopic examination not only requires familiarity with normal and pathological findings but also a solid understanding of the proper procedural technique. This chapter provides a detailed overview of endoscopic techniques, emphasizing the importance of adequate preparation, scope handling, and patient positioning. It begins with the fundamental principles and preparation protocols for both upper and lower endoscopy. The following sections describe step-by-step techniques for performing upper endoscopy and colonoscopy, along with current recommendations for routine tissue sampling and biopsy.

Autoimmune liver diseases involve a heterogeneous group of chronic inflammatory disorders, including autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. Sometimes presented consistently as an overlapping syndrome, their pathogenesis is rather complex and has yet to be fully elucidated, despite extensive research efforts. This review article corroborates the molecular mechanisms of autoimmune liver diseases, as well as existing and potential therapeutic modalities.

Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is a metabolic disease with extensive multi- organ involvement, whose extra-hepatic manifestations include diabetes mellitus type 2, cardiovascular disease, obstructive sleep apnea (OSA), chronic kidney disease, and polycystic ovary syndrome. Our hypothesis was that there was a strong psychological component in NAFLD and OSA suffering patients and that psychotherapy would be helpful in the treatment of the mentioned diseases. Methods: Of 144 initially selected patients (with NAFLD, obesity and OSA), 32 patients agreed to undergo psychotherapy, and 31 therapy-naive NAFLD and OSA patients agreed to participate as controls. Results: Psychological evaluation revealed that self-esteem rose significantly after one-year psychotherapy (p=0.005). Body mass index (BMI) was significantly lower after psychotherapy, followed by the changes in laboratory results. Binomial logistic regression revealed that the reduction of BMI in high probability led to self-esteem improvement (p=0.03). Conclusions: Psychotherapy was an efficient supporting method in the treatment of patients with NAFLD, obesity and OSA. It raised self-esteem and stimulated the motivation for further treatment of obesity, as one of the important factors for NAFLD and OSA. Still, it is advisable to use psychotherapy in combination with other clinical methods of treatment.