Innovative Endoscopic Technologies in the Complex Treatment of Patients with Unstable Stopped Gastroduodenal Bleeding

Abstract

Background: The aim of our research was to improve the results of treatment of patients with unstable bleeding gastroduodenal ulcers (GDUs) through the use of innovative endoscopic technologies in the complex treatment of gastroduodenal bleeding (GDB). Methods and results: The study included 132 patients with unstable ulcerative GDB. Among all patients with GDB, there were 95(71.96%) men and 37(28.04%) women. The average age of patients was 56.1±18.45 years. Among the sources of gastroduodenal ulcer bleeding, duodenal ulcers complicated by bleeding predominated were observed in 77(58.3%) patients, bleeding gastric ulcers and ulcers of gastroenteroanastomosis areas in 49(37.7%) and 6(4.6%) patients, respectively. According to the endoscopic classification (J. Forrest, 1974), continued bleeding (Forrest Ia-Ib) was observed in 44(33.3%) patients, threat of rebleeding (Forrest IIa-IIb) in 88(66.7%) patients. All patients were divided, by random sampling, into two equivalent groups: the main group (MG, n=66) and the comparison group (CG, n=66). In the treatment of MG patients, an individual approach was applied that used the injection of ε-aminocaproic acid, argon-plasma coagulation, and the endoscopic pneumatic applications of hemostatic agents (Zhelplastan and the patient's platelet-rich auto-plasma) and granular sorbents (Aseptisorb-A, Aseptisorb-D). In CG, traditional methods of endoscopic hemostasis (injection method with ε-aminocaproic acid and vasoconstrictor drugs, argon plasma coagulation, etc.) were used without granular sorbents and innovative hemostatic agents. In patients with the Forrest Ia-Ib bleeding, primary EH was achieved in 95.2% of cases in the MG and in 91.3% of cases in the CG (P>0.05). In patients with the Forrest IIa-IIb bleeding, effectiveness of endoscopic prevention of recurrent bleeding was achieved in 95.5% of cases in the MG and in 81.4% of cases in the CG (P=0.047). Mortality rate was 1.5% in the MG and 4.5% in the CG (P>0.05). In the MG and CG, the overall frequency of recurrent bleeding from GDUs, the operational activity, and the length of hospital stay were 15.2% and 4.5% (P=0.041), 12.1% and 1.5% (P=0.033), and 11.1±0.6 days and 9.2±0.4 days (P<0.01), respectively. Conclusion: The developed method for the complex treatment of patients with unstable GDB, based on the optimization of emergency and preventive endoscopic hemostasis, indicates that the use of therapeutic endoscopy to prevent bleeding recurrences with hemostatic agents and granular sorbents improves the reliability of endoscopic hemostasis, reduces the frequency of hemorrhage relapses and the number of emergency operations, as well as a length of hospital stay.

Keywords

• gastroduodenal hemorrhage
• endoscopic hemostasis
• granular sorbents
• hemostatic agents