Gastroduodenal Ulcer Bleeding Research Articles

MORPHOLOGICAL CHARACTERISTICS OF CHANGES IN THE PERIULCEROUS ZONE OF BLEEDING GASTRODUODENAL ULCERS DEPENDING ON THE DEGREE OF BLEEDING ACTIVITY ACCORDING TO FORREST

Despite the signifi cant decrease in morbidity and mortality rates due to peptic ulcer disease of the stomach and duodenum over the past few decades, complications still occur in 10-20 % of patients. Of these, bleeding is the most common complication of peptic ulcers, with an average 30-day mortality of up to 8.6 %. The aim of the study was to evaluate histological changes in the periulcerous zone of active bleeding gastroduodenal ulcers in patients with diff erent degrees of activity of gastroduodenal bleeding according to Forrest. 378 patients with chronic bleeding ulcers of the stomach and duodenum (DPK) were evaluated endoscopically according to the Forrest classifi cation. There were 231 (61.11 %) patients with Forest IA, IB, IIA, IIB, IIS who underwent endoscopic hemostasis (injection therapy or argon plasma coagulation). In 147 (38.89 %) patients, hemostasis was not performed due to the endoscopic pattern of bleeding activity according to Forrest III. A biopsy was taken from the area of periulcerous infi ltrate during endoscopic diagnosis before hemostasis on the day of hospitalization. It has been established that endoscopic bleeding stigmata have morphological features depending on the severity of destructive, infl ammatory and regenerative changes in periulcer tissues. Microscopic analysis of biopsies of periulcerous infi ltrate in bleeding gastroduodenal ulcers allows predicting the probability of recurrence of bleeding.

Role of Interventional Radiology (IR) in vascular emergencies among cirrhotic patients.

Gastrointestinal hemorrhage remains one of the most common causes of morbidity and mortality among patients with liver cirrhosis. Mostly, these patients bleed from the gastroesophageal varices. However, nonvariceal bleeding is also more likely to occur in these patients. Because of frequent co-existing coagulopathy, cirrhotics are more prone to bleed from a minor vascular injury while performing percutaneous interventions. Ultrasound-guided bedside vascular access is an essential procedure in liver critical care units. Transjugular portosystemic shunts (TIPS) with/without variceal embolization is a life-saving measure in patients with refractory variceal bleeding. Whenever feasible, balloon-assisted retrograde transvenous obliteration (BRTO) is an alternative to TIPS in managing gastric variceal bleeding, but without a risk of hepatic encephalopathy. In cases of failed or unfeasible endotherapy, transarterial embolization using various embolic agents remains the cornerstone therapy in patients with nonvariceal bleeding such as ruptured hepatocellular carcinoma, gastroduodenal ulcer bleeding, and procedure-related hemorrhagic complications. Among various embolic agents, N-butyl cyanoacrylate (NBCA) enables better vascular occlusion in cirrhotics, even in coagulopathy, making it a more suitable embolic agent in an expert hand. This article briefly entails the different interventional radiological procedures in vascular emergencies among patients with liver cirrhosis.

New Signaling Systems of Nitric Oxide (No) and Vascular Adhesion Molecule Svcam-1 in the Diagnosis of Recurrent Ulcerative Gastroduodenal Bleeding

In this article, we presented the results of studying the prognostic significance of various clinical, laboratory, endoscopic factors, indicators of the severity of the patient's condition according to APACNE-III, the severity of blood loss and hemorrhagic shock, comorbidity and factors of the blood coagulation system in predicting the risk of bleeding in patients with peptic ulcer complicated by acute gastro-duodenal ulcerative bleeding. In a certain number of patients with acute gastroduodenal ulcerative bleeding, along with quantitative and qualitative risk factors for bleeding, the indicators of NO and sVCAM-1 were studied in a comparative aspect and their correlation was determined.

Risk factors for rebleeding in gastroduodenal ulcers.

Rebleeding after hemostasis of the gastroduodenal ulcer (GDU) is one of the indicators associated with death among GDU patients. However, there are few studies on risk score that contribute to rebleeding after endoscopic hemostasis of bleeding peptic ulcers. The aim of this study was to identify factors associated with rebleeding, including patient factors, after endoscopic hemostasis of bleeding gastroduodenal ulcers and to stratify the risk of rebleeding. We retrospectively enrolled 587 consecutive patients who were treated for Forrest Ia to IIa bleeding gastroduodenal ulcers with endoscopic hemostasis at three institutions. Risk factors associated with rebleeding were assessed using univariate and multivariate logistic regression analyses. The Rebleeding Nagoya University (Rebleeding-N) scoring system was developed based on the extracted factors. The Rebleeding-N score was internally validated using bootstrap resampling methods. Sixty-four patients (11%) had rebleeding after hemostasis of gastroduodenal ulcers. Multivariate logistic regression analysis revealed four independent rebleeding risk factors: blood transfusion, albumin <2.5, duodenal ulcer, and diameter of the exposed vessel ≧2mm. Patients with 4 risk factors in the Rebleeding-N score had a 54% rebleeding rate, and patients with 3 risk factors had 44% and 25% rebleeding rates. In the internal validation, the mean area under the curve of the Rebleeding-N score was 0.830 (95% CI = 0.786-0.870). Rebleeding after clip hemostasis of bleeding gastroduodenal ulcers was associated with blood transfusion, albumin <2.5, diameter of the exposed vessel ≧2mm, and duodenal ulcer. The Rebleeding-N score was able to stratify the risk of rebleeding.

Factors influencing outcome of angiographic embolization for gastroduodenal hemorrhage related to peptic ulceration

PurposeLong-term outcome and prognostic factors of transcatheter embolization for gastroduodenal peptic ulcer bleeding are unknown. This study was conducted to evaluate the clinical outcome and factors associated with early recurrent bleeding and 30-day mortality of transcatheter arterial embolization (TAE) for severe, upper gastroduodenal hemorrhage associated with peptic ulcer and refractory to medical and endoscopic therapy. MethodsA monocenter, retrospective study from 2005 to 2020 including 76 consecutive patients who underwent TAE as first-line therapy for bleeding gastroduodenal peptic ulcers refractory to endoscopic therapy. Patient demographics, endoscopy findings, co-morbidities and interventional procedure findings were recorded. The outcome measures were technical and clinical success, procedure related complications, recurrent bleeding, length of hospital stay, 30-day mortality and overall survival. ResultsThe technical success rate was 96% and the clinical success rate was 65,8%. The rebleeding and 30-day mortality rate were 30,7% and 22,4% respectively. A higher international normalized ratio (INR) was a statistically significant risk factor for 30-day mortality (OR, 7.15; 95% CI, 1.67–30.70; p = 0.008). The mean overall survival was 3.76 years (1.16–––5.09; 95% CI); a lower Charlson Comorbidity Index (CCI) and a lower Rockall score were significantly associated with a longer overall survival (HR, 1.24; 95% CI, 1.14–1.35; p = 0.0001; HR, 1.32; 95% CI, 1.10–1.59; p = 0.003) respectively. Early rebleeding was significantly associated with a lower overall survival (HR, 2.72; 95% CI, 1.57–4.71; p = 0.0004). ConclusionA higher INR was a significant risk factor with a higher 30-day mortality. A lower CCI, a lower Rockall score and the absence of early rebleeding were significantly associated with a longer overall survival.

Results of using transcatheter arterial embolization in gastroduodenal ulcer bleeding: a review of studies

The authors present the results of research comparing the efficacy and safety of different methods of hemostasis in patients with gastrointestinal ulcer bleeding. The work focuses on the possibilities of transcatheter arterial embolization (embolization of the syndrome-responsible arteries of the stomach and duodenum) in the treatment of this disorder. Objective. Based on information sources, to evaluate the potential of transcatheter arterial embolization in comparison with the results of surgical and endoscopic hemostasis in the management and prevention of recurrent gastroduodenal ulcer bleeding. Materials and methods. The authors analyzed data from 51 domestic and international information sources on the subject of this work. Results. Studies on the treatment of active ulcerative gastroduodenal bleeding refractory to endoscopic hemostasis, have demonstrated the advantage of transcatheter arterial embolization over surgical interventions in terms of the incidence of non-fatal surgical complications. Surgical interventions were associated with a lower incidence of recurrent bleeding compared to endovascular interventions. According to research results, there were no difference in overall mortality between the groups of endovascular and surgical hemostasis. The use of prophylactic transcatheter embolization of the syndrome-responsible artery in cases of ulcerative gastroduodenal bleeding in addition to effective primary endoscopic hemostasis showed promising results. In such cases, patients with initially high risk of hemorrhagic complications had significantly lower rate of recurrent bleeding, surgical complications, and mortality comparing to patients with effective primary endoscopic hemostasis but without subsequent transcatheter arterial embolization. Conclusion. Despite current advances in the field of surgery ulcerative gastroduodenal bleeding remains an acute medical and social problem that requires the search for new effective methods of hemostasis and prevention of recurrent hemorrhagic complications. In the majority of studies, transcatheter embolization of the syndrome-responsible arteries of the stomach and duodenum is used as such. Keywords: gastrointestinal ulcer bleeding, endoscopic hemostasis, transcatheter arterial embolization, prophylactic endovascular embolization

Еndovascular embolization as a prevention of recurrent bleeding from the upper gastrointestinal tract

Goal: to evaluate the results of the use of preventive endovascular hemostasis in patients with a high risk of recurrent bleeding from the upper gastrointestinal tract. Material and methods. The work is based on the study of the results of 158 patients with ulcerative gastroduodenal bleeding and a high risk of its recurrence treatment (17 points or more on the scale of the recurrence of bleeding prediction), Forrest 1–2 A/B and fatal cases (30 points or more on SAPS II). To prevent recurrent bleeding, endovascular embolization of the left gastric or gastroduodenal arteries was performed. Results. The technical success of endovascular hemostasis was achieved in 94.4% of cases (153 patients). In 5 patients, embolization could not be performed due to technical reasons. A complication after transcatheter angiography and embolization was noted in one case (retroperitoneal hematoma that required surgical intervention). Relapse of bleeding after technically successful embolization was noted in 11 (7%) patients. PVA microemboli were used for embolization of the left gastric artery (LVA). Spirals and, in some cases, additional PVA microemboli were used for embolization of the gastroduodenal artery (GDA). The fatal outcome occurred in 26 cases (16.5% of all cases). Conclusion. According to our data, 7% of patients with severe somatic diseases (30 points or more according to SAPS II) and a high risk of bleeding recurrence (17 points or more according to SRBP) occurred in 7% (11 out of all 158 cases).

X-RAY endovacular embolization in the treatment of ulcerate gastroduodenal bleeding

The use of targeted arterial embolization in the treatment of bleeding ulcers was accompanied by technical success in 97.6% of cases, clinical success in 95% of cases, bleeding recurrence occurred in 5% of patients, while repeated arterial embolization was used to eliminate it in 2.5% of cases. Delayed operations were performed in 8.3% of patients, mortality was 6.5%, which allows us to recommend transcatheter arterial embolization for the treatment of patients with ulcerative gastroduodenal bleeding.

Endovascular embolization for prevention of recurrent bleeding from the upper gastrointestinal tract

To evaluate the results of preventive endovascular hemostasis in patients with high risk of recurrent bleeding from the upper gastrointestinal tract. We analyzed treatment outcomes in 158 patients with ulcerative gastroduodenal bleeding and high risk of recurrence (≥17 scores), Forrest 1-2 A/B and mortality (SAPS II score ≥30). Endovascular embolization of the left gastric or gastroduodenal artery was performed to prevent recurrent bleeding. Endovascular hemostasis was technically successful in 94.4% of cases (153 patients). Embolization could not be performed due to technical reasons in 5 patients. One patient developed retroperitoneal hematoma as a complication after transcatheter angiography and embolization that required surgical intervention. Recurrent bleeding after technically successful embolization occurred in 11 (7%) patients. The PVA microemboli and spirals were used for embolization of the left gastric and gastroduodenal arteries, respectively. Additional PVA microemboli were also used in gastroduodenal artery in some cases. Twenty-six (16.5%) patients died. Endovascular hemostasis in patients with severe comorbidities (SAPS II score ≥30) and high risk of recurrent bleeding (≥17 scores) reduced the incidence of recurrent bleeding to 6.96% and mortality to 17%.

Prospects for development of laparoscopic surgery in the Central Federal District of the Russian Federation

To analyze the achievements of laparoscopic surgery in the Central Federal District of Russia and outline perspective trends for further application. The study included adult patients with abdominal surgical diseases hospitalized in general surgical departments of the Central Federal District between 2014 and 2021. We analyzed the prevalence of elective and emergency laparoscopic surgeries. Incidence and results of laparoscopic interventions between 2018 and 2021 were estimated considering primary statistical data presented in the annual collections of the Chief Surgeon of the Ministry of Health of Russia «Surgical care in the Russian Federation». The absolute number of laparoscopic surgeries in the Central Federal District increased from 23.686 to 80.489 (by 3.4 times) between 2014 and 2021. The annual number of elective laparoscopic surgeries exceeded the number of emergency ones up to 2019. In 2020-2021, this situation changed in favor of emergency abdominal procedures. Laparoscopic surgeries are the most common for in acute cholecystitis (71.06-81.10% of all laparoscopic interventions annually) and acute appendicitis (46.85-55.60%). In 2020 and 2021, the absolute number of laparoscopic appendectomies exceeded the number of laparoscopic cholecystectomies. These values are lower for perforated ulcers (15.44-20.39%) and acute pancreatitis (32.40-36.71%). Laparoscopic operations are rare for acute intestinal obstruction, strangulated hernia and ulcerative gastroduodenal bleeding. In elective surgery, high availability of laparoscopic surgeries was noted in patients with cholelithiasis (89.40-93.78%), hiatal hernia (62.12-77.27%) and adrenal gland diseases (64.23-87.25%). The most intensive increment of availability (by 2.4 times) was noted for inguinal hernia from minimum level (10.98%) in 2018 to 26.00% in 2021. Mortality after some laparoscopic operations decreased in comparison with laparotomy by 12-45 times (2018-2021). However, this aspect and results of laparoscopic surgeries in case of delayed hospitalization require additional study. Analysis of laparoscopic surgery showed the timeliness of beginning and development of this direction In Russia. The prospect of further development of laparoscopic surgery for abdominal diseases is determined by modern trends. These are increase in the number of laparoscopic operations for acute appendicitis, acute cholecystitis and perforated ulcers, as well as higher number of early (after admission) operations.

Факторы риска летального исхода при острых язвенных гастродуоденальных кровотечениях

The most common cause of acute nonvariceal bleeding from the upper gastrointestinal tract (GIT) is ulcerative lesions of the stomach and duodenum. The aim of the present study was to investigate the structure of mortality in acute ulcerative gastroduodenal bleeding (AUGDB) and the influence of concomitant pathology, as well as to evaluate the possibilities of prognostic systems for determining the risk of lethal outcome. The study included 374 patients, 77 (20.6%) of them died, 12 (15.6%) patients had recurrence of ulcer bleeding. The risk factors for AUGDB include severe degree of blood loss with a change in shock index (SI) &gt;0.8 in comorbid patients, multiple gastric and duodenal ulcer defects. A separate risk factor is an episode of AUGDB during inpatient treatment as a complication of the underlying disease. Rockall, Glasgow-Blatchford and PNED scales can be used to predict the lethal outcome, with the best results demonstrated by the PNED system: sensitivity 84.4% and specificity 77.4%.

PECULIARITIES OF TACTICS USING ENDOSCOPIC HEMOSTASIS IN RECURRENT GASTROINTESTINAL BLEEDING

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.&#x0D; 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%.&#x0D; 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%.

Proton pump inhibitors in the treatment of gastroduodenal ulcer bleeding: optimization of drug therapy methods

Currently, peptic ulcer disease remains the most common disease of the digestive system. Ulcerative bleeding is a terrible complication. The main condition for the successful conservative treatment of gastrointestinal bleeding that occurs against the background of acid-dependent diseases is adequate acid-reducing therapy. We conducted a study comparing the different modes of administration of proton pump blockers. To this end, three groups of the study were formed: the first group: the drug Rabeprazole was obtained as an antisecretory therapy. The dosing regimen consisted in the introduction of a bolus of 80 mg, then a constant infusion of the drug at a rate of 8 mg per hour for the first 72 hours, after which the transfer to the oral form of 20 mg ×2 times a day; the second group: received the drug rabeprazole intravenously in a dosage of 40 mg 2 times a day; the third group: received the drug rabeprazole intravenously in a dosage of 20 mg 2 times a day for the first 72 hours, then transfer to the oral form of 20 mg ×twice a day. The use of PPIs in various dosages in the study groups significantly reduced the risk of bleeding relapses and deaths. We have shown that the use of PPIs in reduced dosages is also an effective method of treating patients with ulcerative gastroduodenal bleeding.

Comparison of the Degree of Gastric Mucosal Injury between Patients Who Are Receiving Dual Antiplatelet Therapy or Single Antiplatelet Therapy.

Background: Patients taking low-dose aspirin have a higher incidence of gastroduodenal ulcers and higher risk of upper gastrointestinal bleeding than patients who do not. Thienopyridine antiplatelet agents may similarly cause bleeding gastroduodenal erosions and ulcers. The incidence of gastrointestinal bleeding is reported to be higher when these antithrombotic drugs are used in combination. Until now, most studies have focused on bleeding, and no study has compared the degree of gastric mucosal injury between patients receiving dual antiplatelet therapy (DAPT) and those receiving single antiplatelet therapy (SAPT) in real-world clinical practice. Aim: Our objective was to compare the degree of gastric mucosal injury in patients taking low-dose aspirin in combination with clopidogrel (one of the thienopyridine antiplatelet agents) with that of patients who were taking aspirin or clopidogrel as a single agent. Methods: Patients who were taking aspirin and/or clopidogrel and who underwent scheduled esophagogastroduodenoscopy between April 2015 and March 2020 were enrolled in this study. Endoscopic images were reviewed retrospectively, and the degree of gastric mucosal injury was assessed with the modified Lanza score (m-Lanza score). The m-Lanza score was compared between DAPT patients taking aspirin and clopidogrel and SAPT patients taking either aspirin alone or clopidogrel alone. Results: The m-Lanza scores of the DAPT group, the aspirin group, and the clopidogrel group were 1.67 ± 1.81 (mean ± standard deviation), 0.95 ± 1.61, and 0.72 ± 1.29, respectively. The m-Lanza score of the DAPT group tended to be higher than that of the aspirin group (p = 0.06) and was significantly higher than that of the clopidogrel group (p = 0.03). Conclusion: The degree of gastric mucosal injury in DAPT patients was significantly higher than that in patients using clopidogrel alone and tended to be higher than that in patients using aspirin alone in real-world clinical practice.

Modern Technologies of Endoscopic Hemostasis in the Treatment of Ulcer Gastroduodenal Bleeding: A Literature Review

The treatment of upper gastrointestinal bleeding (UGIB) remains one of the complex problems of clinical practice. In the structure of UGIB, 30%-60% of cases are occupied by bleeding of ulcerative etiology. Success in treating patients with ulcerative gastroduodenal bleeding is possible only with the use of an integrated approach that includes endoscopic, medicinal, endovascular, and surgical hemostasis technologies. In contrast, endoscopic hemostasis (EH) is crucial in the treatment of such patients. The use of modern advances in endoscopy can significantly improve the treatment results of patients with UGIB, reducing the number of operations and mortality in this severely affected group of patients. Modern therapeutic endoscopy has a wide arsenal of tools that can reliably stop bleeding. They differ from each other in the nature of impact, effectiveness, availability, safety, and cost. This article presents an overview of the technological and clinical features of hemostasis, modern views on the choice and application of methods of EH for ulcerative gastroduodenal bleeding.

Surgical tactics for ulcerative gastroduodenal bleeding in the practice of air ambulance

Analysis of the results of treatment of patients with ulcerative gastroduodenal bleeding based on the annual reports of surgical departments of city and district hospitals of the Chuvash Republic shows that in recent years the number of patients with gastrointestinal bleeding has increased, as well as the number of operated patients (see table).

P-EGS13 Risk Factors of Bleeding Gastroduodenal Ulcer Among Patient Undergo Emergency Upper Endoscopy in Hospital Melaka

Abstract Background Bleeding gastroduodenal ulcer has been one of the leading causes of admission in surgical or gastroenterology departments all over the world, requiring immediate intervention with high associated mortality exceeding 10%. We analyzed few important risk factors that lead to this potentially ill condition. Methods Data from a number of 548 patients who underwent emergency upper endoscopy were collected retrospectively from June 2020 till June 2021 in Hospital Melaka. Results From our data collection of emergency upper endoscopy performed, 111 patients had findings of high-risk ulcer (Forrest Ia, Ib, 2a and 2b). From these 111 patients, the most common presentation was low hemoglobin value (&amp;lt;10g/dL), with 43.6%. Presentation of melena encountered the second most common symptom (26.3%), while fresh per rectal bleeding counts the less common symptom (1%). Forrest Ib ulcer showed the commonest diagnosis found during endoscopy (45.5%), followed by Forrest IIa ulcer (34.5%), Forrest IIb ulcer (16.4%), and Forrest Ia ulcer (3.6%). There were 27 participants who undergo repetitive endoscopy. For Helicobacter Pylori infection, there were 367 patients (66.7%) underwent the test during endoscopy, which showed 187 patients detected (51%) with H.Pylori positive. We identify other risk factors which lead to this fatal condition such as, patient’s comorbidities including liver disease, renal disease and their medications, blood investigations including hemoglobin level, platelet count, total white cell count, total bilirubin, Alanine Transaminase (ALT), serum urea and creatinine. Conclusions It is a must to identify important risk factors for bleeding gastroduodenal ulcers to prevent morbidity and mortality, and to initiate emergency intervention medically and surgically. From this study, it was a great move for us to make further research on how these risk factors affecting our management of patients.

Modern Clinical and Epidemiological Features and New Technological Possibilities in the Treatment of Bleeding Gastroduodenal Ulcers

The aim of this research was to study the current clinical and epidemiological features of ulcerative gastroduodenal bleeding (GDB) and to evaluate the outcomes of using new technological approaches in patients with bleeding from acute (symptomatic) and chronic (peptic ulcer disease) gastroduodenal ulcers (GDUs). Methods and Results: The present study involved 221 patients with bleeding GDUs. Depending on the source of bleeding, all patients were divided into 2 groups. Group 1 included 143 patients with acute symptomatic GDUs; Group 2 consisted of 78 patients with peptic ulcer disease complicated by bleeding. In the complex treatment of patients of all the studied groups, an individual approach was used that included the innovative technologies of endoscopic cytoprotective treatment of GDB, based on the combined use of traditional means of EH in combination with the use of endoscopic pneumoinsufflation of biologically active drainage sorbent of a new generation Aseptisorb-D and powdered hemostatic Zhelplastan. Our analysis showed that acute symptomatic GDUs prevailed in the structure of GDB – 143(64.7%) patients; PUD complicated by bleeding was diagnosed in 78(35.3%) cases. The use of new technological approaches, including cytoprotective treatment of bleeding defects with biologically active draining sorbents of a new generation in combination with local hemostatics in the complex therapy of patients with ulcerative GDB, has significantly improved the results of treatment, which is confirmed by high rates of final hemostasis (95.0%), indicators of the effectiveness of primary EH in type FIA-IB (93.1%) and prevention of recurrence of FIIA-IIB bleeding (92.5%), with a low frequency of repeated bleeding (4.07%), emergency surgeries (2.7%), and mortality (3.2%). Conclusion: Currently, in the structure of ulcerative GDB, acute symptomatic GDUs are the most common – 64.7%, and the share of PUD complicated by bleeding accounts for 35.3% of cases only. PUD and GDUs complicated by bleeding have certain clinical and epidemiological features, which must be taken into account when treating these patients. Symptomatic GDUs are more difficult to treat, which shows the need to develop new complex technologies for their treatment.

The results of using endovascular methods for stopping ulcerative gastroduodenal bleeding

This article presents the results of treatment of patients with ulcerative gastroduodenal bleeding who were treated in the 2nd clinic (surgery for the improvement of doctors) Military Medical Academy at the I.I. Dzhanelidze Research Institute of Emergency Medicine. A retrospective analysis was conducted of the frequency of rebleeding, surgical activity and mortality in groups with the use of transcatheter arterial embolization with and without it. The criteria for inclusion in the study were: the presence of ulcerative gastroduodenal bleeding, confirmed by laboratory and instrumental methods of examination, severe general somatic condition of patients. The comparison was carried out in the main and control groups. The main group consisted of 20 patients who underwent endovascular hemostasis. The control group included 46 patients without the use of X-ray surgical methods. The average age of patients in the main and control groups was 65.5 3.7 and 60.7 3.9 years. In both groups, most patients were admitted later than 24 hours after the onset of the disease and with severe blood loss. The severity of the somatic state of the intervention was assessed according to the APACHE II multiple organ failure assessment scale, according to which, patients in the main group were somatically more severe than in the control group. In the groups, bleeding from stomach ulcers prevailed (up to 75%). Most often, endovascular hemostasis is performed at a high risk of recurrent bleeding, and adhesive compositions and spirals were used as an embolizing agent. Angiography revealed direct or indirect signs of bleeding (extravasation, hypervascularization, aneurysmal dilatation) in 12 cases, and preventive embolization was performed in 8 cases. In 70% of cases, the source of bleeding was the left gastric artery. In the control group, recurrent bleeding and surgical activity accounted for 26%. In the main group, 20% and 15%, respectively. In the main group, recurrent bleeding occurred in 4 cases, 1 patient underwent repeated endoscopic hemostasis, 3 patients underwent open surgical interventions. All 4 patients had a fatal outcome, against the background of massive blood loss and aggravated somatic pathology. The overall mortality rate in the control group was 44%, in the main group 35%. Transcatheter arterial embolization did not significantly improve the results of treatment of ulcerative gastroduodenal bleeding due to the severity of the general somatic condition of the patients included in the study.

APPLICATION OF MODERN METHODS OF ENDOSCOPIC HАEMOSTASIS IN THE TREATMENT OF GASTRODUODENAL ULCER BLEEDING

Summary. The aim of the study is to improve the results of treatment of patients with ulcerative gastroduodenal bleeding by using the methods of endoscopic hаemostasis.&#x0D; Materials and research methods. The results of endoscopic hаemostasis of 153 patients who were treated in the surgical department of the “Regional Clinical Hospital” were analyzed. Patients were examined clinically, laboratory and instrumental.&#x0D; Results and its discussion. For Forrest 1a, b bleeding, endoscopic clipping was used in 16 (10.4 %) patients with a visualized vessel in the bottom of the ulcer. In the studied patients of this group, there were no relapses of bleeding. Diathermy coagulation was used in 42 (27.5 %) patients. Recurrent bleeding was observed in 6 patients. Submucosal infiltration was performed in 37 (24.2 %) patients with ulcerative bleeding. Repeated bleeding was recorded in 9 patients within the next 3 hours after the intervention and in 7 patients during the first days after endoscopic hаemostasis. Combinations of endoscopic methods of hаemostasis were used in 58 (37.9 %) patients.&#x0D; Conclusions. The use of modern methods of endoscopic hаemostasis followed by adequate pharmacotherapy in most cases allows achieving a final stop of bleeding. Patients with a high risk of recurrent bleeding and a low surgical and anesthetic risk after successful endoscopic hаemostasis are shown surgical intervention before the development of recurrent bleeding.