Treatment Of Gastroduodenal Bleeding Research Articles

СОВРЕМЕННЫЕ ПОДХОДЫ К ЛЕЧЕНИЮ ГАСТРОДУОДЕНАЛЬНЫХ КРОВОТЕЧЕНИЙ В НЕОТЛОЖНОЙ ХИРУРГИИ В СПЕЦИАЛИЗИРОВАННОМ ГОРОДСКОМ ЦЕНТРЕ

Background. Gastroduodenal bleeding (GDB) is one of the most urgent problems of emergency abdominal surgery. The frequency of detection of bleeding of non-ulcer origin, which in the past was practically not diagnosed, has increased recently due to the widespread introduction of high-tech diagnostic techniques into clinical surgical practice. Diagnostic and therapeutic algorithms for GDB of ulcerative and non-ulcerative etiology are quite clearly defined, but the problem remains relevant due to the fact that the number of patients with acute GDB does not tend to decrease. The tactics of treating bleeding requiring emergency surgery remain debatable. Purpose. To evaluate the results of treatment of gastroduodenal bleeding of ulcerative and non-ulcerative origin requiring emergency surgery performed in a specialized city center for gastroduodenal bleeding. Material and methods. The experience of emergency care and treatment of 1061 patients with GDB in a specialized center is presented. Results. FGDS was performed on admission in all patients; ulcer bleeding was diagnosed in 809 (76.2%) patients; non-ulcer bleeding in 252 (23.8%) patients. Bleeding from gastric ulcers was detected in 227 (30.3%) patients, from duodenal ulcers – in 582 (69.7%) patients. Endohemostasis was performed for continued bleeding during FGDS. The treatment was based on the generally accepted complex of conservative therapy according to the clinical protocols for managing patients with GDB. Сonclusion. An analysis of the results of treatment of patients hospitalized in the city center for GDB showed that at the present stage endohemostasis is effective in 98.4% of ulcer bleeding and in 96.0% of non-ulcer bleeding.

Comparative Analysis Of The Results Of The Endoscopic Treatment Of Gastroduodenal Ulcerative Bleeding

The study includes 557 patients with ulcer of the stomach and duodenal intestine complicated by bleeding. The control group was 290 patients, of which 48 patients with active bleeding were performed by standard endoscopic hemostasis techniques, and in 242 cases, when verifying stopping bleeding, endoscopy was limited to the diagnostic step with subsequent conservative patient management. The main group includes 267 patients in addition to endoscopic hemostasis with active bleeding (46 patients), the manipulation was supplemented with the implementation of the proposed method of endoscopic treatment of gastroduodenal bleeding of ulcerative genesis. When revealed bleeding (221 patients), endoscopic intervention was also accompanied by the implementation of the proposed method. The application of the composite polymer material over the ulcerative defect contributed to a decrease in the frequency of the nearest recurrences of hemorrhagic syndrome from 9.0% to 1.9%, reduce the need to perform operational treatment from 6.6% to 1.1% and levity indicator from 1.7% up to 0.7%, which generally affected the increase in the share of patients discharged without complications from 90.7% to 97.8% and reducing the timing of the hospital phase of treatment.

PROFESSOR IVAN NIKIFOROVICH PIKSIN (to the 85th anniversary of the birth)

The article is dedicated to the 85th birthday of the famous scientist, honored worker of science of the Russian Federation, honored worker of science of the Republic of Mordovia, honored doctor of the Republic of Mordovia, laureate of State prize, head of the scientific-pedagogical surgical school, doctor of medical Sciences professor Piksin Ivan Nikiforovich. I. N. Piksin is the author of fundamental studies of the biomedical effects of quantum radiation at the molecular, cellular and organismal levels in patients with acute destructive diseases of the lungs, purulent-septic diseases, lactational mastitis and other pathologies. The team of the scientific-pedagogical school led by I. N. Piksin explores the problems of diagnosis and treatment of gastroduodenal bleeding, mechanical jaundice, pancreatitis, suppurative diseases of the lung and pleura, surgical diseases of the heart, blood vessels, prevention of complications of limb injuries, diabetes and diabetic foot care, pediatric orthopedics. Under the leadership of I. N. Piksin, new minimally invasive technologies have introduced: transthoracic drainage and rehabilitation therapy of purulent cavities of the lung and pleura, percutaneous and transhepatic cholecystocholangiography, diagnostic and treatment interventions in space-occupying lesions of the abdomen and thyroid gland, ultrasound techniques of diabetes in acute destructive pancreatitis and others. He is considered as one of organizers of higher medical education system in the region. The professor is actively working on improvement in training of medical and scientific personnel for various regions of the Russian Federation.

Gastroduodenal bleeding in patients with acute cerebrovascular accident

INTRODUCTION. Gastroduodenal bleedings often occurs among patients with cerebrovascular accident (CVA). The frequency, causes and treatment tactics for bleeding from the upper gastrointestinal tract (GIT) in this group of patients have not been sufficiently studied. There were no well established guidelines of treatment for this group of patients, that could be a reason for high mortality. The OBJECTIVE of the study was to improve the treatment outcome of gastroduodenal bleeding cases in patients with cerebrovascular accident (CVA) by using conservative and endoscopic methods that could be used to stop bleeding and developing tactics of treatment in this category of patients. MATERIAL AND METHODS. There were 105 patients with cerebrovascular accident (CVA) and signs of bleeding from the upper gastrointestinal tract in the study. Patients were admitted to the St. Petersburg City Mariinsky Hospital from 2013 to 2018 years. Patients were divided into 2 groups, regarding the type of cerebrovascular accident (CVA): patients with ischemic stroke and patients with hemorrhagic stroke. All patients underwent esophagogastroduodenoscopy (EGD) during 2 hours from identifying the signs of bleeding. RESULTS. In this study, we analyzed medical files and records of patients with diagnosis of ischemic or hemorrhagic stroke, who were admitted to St. Petersburg City Mariinsky Hospital from 2013 to 2018 years. During the observation of patients with diagnosis of ischemic or hemorrhagic stroke, 7483 patients and 1919 patients respectively were treated in the clinic. Among these patients, 58 patients were with diagnosis of acute stroke with ischemic type and 47 patients with acute hemorrhagic stroke in combination with bleeding from upper parts of a GIT. The frequency of the upper GI bleeding was 0.77 % (58 of 7483) in the group with ischemic type of stroke; in the group of patients with hemorrhagic stroke, gastroduodenal bleeding was diagnosed in 2.45 % (47 of 1919) cases. CONCLUSIONS. Endoscopic treatment of gastroduodenal bleeding in cases of ischemic and hemorrhagic stroke was the method of choice. The combined endoscopic hemostasis method was preferred. To achieve hemostasis in cases of superficial lesions of the mucous membrane of the upper gastrointestinal tract and acute ulcers of the gastroduodenal zone in combination with CVA, Argon plasma coagulation (APC) was effective. It was possible to combine APC with other methods of endoscopic hemostasis that improved the results of treatment and reduced the risk of recurrent bleeding. If bleeding was from chronic ulcers of the stomach and / or duodenum, the method of clipping was effective in combination with APC and / or with injection method. When signs of recurrence of bleeding appeared, all patients with CVA should have undergone esophagogastroduodenoscopy (EGD) and hemostasis by endoscopic methods. All patients with CVA and gastroduodenal hemorrhages combination should have undergone anti-ulcer drug therapy.

Treatment of gastroduodenal bleeding by infiltration hemostasis with the use of collagen biomaterial

Treatment of gastroduodenal bleeding by infiltration hemostasis with the use of collagen biomaterial

BLEEDING PEPTIC ULCER

AMONG the many wound stripes incident to modern civilization perhaps the one which looms most prominent yet remains most perplexing is the problem of peptic ulcer and its perilous complications. About 8,800 persons die annually in the United States alone from the sequelae of peptic ulcer, and massive hemorrhage due to ulcer is a grim contributor to this excessive toll. Recent therapeutic procedures in the treatment of peptic ulcer have produced many changes of opinion. However, there still remains much controversy over the treatment of gastroduodenal bleeding. Is surgery indicated and, if so, for which patients? When is the optimal time to operate and what is the operation of choice? What is the present status of transfusions and parenterally administered fluids? Is morphine contraindicated? Is it best to feed patients promptly or to starve them? What is the current trend in antacid therapy? Are amino acids helpful? Is vagotomy the