Abstract
At present, endoscopic haemostasis is the main method to arrest bleeding and to prevent its recurrence in patients with gastroduodenal ulcer bleeding, but there is still no consensus on the superiority of one or another method of endoscopic haemostasis. Now, according to many specialists, the recurrence of ulcer bleeding is no longer an absolute indication for surgical treatment, especially in individuals with severe somatic diseases, but serves as an indication for repeated endoscopic haemostasis. The purpose of the study was to compare the effectiveness of different methods of endoscopic haemostasis in the prevention of ulcer bleeding recurrence, as well as to study the feasibility of repeated endoscopic haemostasis in case of bleeding recurrence.
 The study is based on the analysis of the treatment of 268 patients with gastrointestinal bleeding who were urgently admitted to surgical departments. Primary endoscopic haemostasis was performed in 142 (52.9%) cases: argon plasma coagulation was used in 56 (39.5%) observations, the injection method was used in 47 (33%) observations, and their combination was used in 39 (27.5%) observations. According to the research data, the majority of recurrences, 34 (51.5%) cases, occurred within the first day following the admission to the hospital. The study of the probability of bleeding recurrence depending on the initial intensity (Forrest) determined that the frequency of the recurrence is statistically higher in class I-A and I-B than in II-A and II-B. Out of 66 patients with recurrent bleeding, repeated haemostasis was found to be effective in 51 (77.3%). At the same time, the efficiency of the injection method made up 60%, argon plasma coagulation was found as more effective (81.4%), and the combined approach demonstrated the highest efficacy of 94.7%.
 According to the results, we can suggest that in case of bleeding recurrence, repeated endoscopic haemostasis is a quite adequate alternative to the surgical treatment, especially in patients with severe somatic diseases. The use of endoscopic repeated haemostasis in case of recurrent bleeding can reliably reduce the mortality rate from 28 to 13.6%.
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