First experience of using alginate polymer polysaccharide hemostatic hydrogel in complex endoscopic treatment of unstable gastroduodenal ulcer bleeding: Clinical cases

Abstract

Background. Gastroduodenal ulcer bleeding continues to be a serious problem in modern emergency surgery. Early intensive therapy combined with endoscopic hemostasis remains crucial for successful treatment of patients with ulcerative hemorrhages. The problem of recurrent bleeding, which is recorded in 12–33% of cases, even when using combined methods of endoscopic hemostasis, is still the most difficult challenge in the treatment of patients with ulcerative bleeding. The search for new approaches in the endoscopic treatment of bleeding gastroduodenal ulcers is considered to be highly relevant.Description of clinical cases. The present paper describes the experience of using an alginate polymer polysaccharide hemostatic hydrogel in the complex treatment of two patients with unstable bleeding from duodenal ulcers. Patient B., 70 years old, with severe somatic pathology and a history of ulcers for 20 years, was admitted to the Voronezh City Clinical Emergency Hospital No. 1 with gastroduodenal ulcer bleeding. According to urgent esophagogastroduodenoscopy, the patient was diagnosed with a bleeding ulcer of the anterior wall of the duodenum with unstable bleeding (Forrest IIA). A large thrombosed vessel 2 mm in diameter was detected in the ulcer base. Patient K., 50 years old, suffering from type II diabetes mellitus for 4 years, was admitted to an emergency hospital with Forrest IIB bleeding from an extensive ulcerative defect of the duodenum. The complex treatment of patients involved a personalized approach using an alginate polymer polysaccharide hemostatic hydrogel during therapeutic endoscopy. After applying a powdered alginate hemostatic agent, a transparent hydrogel tightly fixed to the ulcer was formed on the surface of the ulcerative defect, which remained on the surface of the defect for up to 3–4 days and provided a prolonged hemostatic effect without any damaging effect on the ulcer and the surrounding mucous membrane of the duodenum. Transendoscopic application of an alginate polymer polysaccharide hemostatic hydrogel on the surface of a bleeding ulcer in the complex treatment of unstable ulcer bleeding prevented recurrent bleeding and ensured proper healing of the ulcer defect, thereby improving treatment results for patients with complicated peptic ulcer disease.Conclusion. Clinical observations have shown that the use of alginate polymer polysaccharide hemostatic hydrogels in combined endoscopic treatment of unstable gastroduodenal ulcer bleeding reliably prevents recurrence of hemorrhage, stabilizes the condition of patients in the early stages, improves the quality of healing of a bleeding ulcerative defect, thereby suggesting the prospects of use of this hemostatic in the treatment of gastroduodenal ulcer bleeding. However, the present paper describes only the first experience of the clinical use of hemostatic alginate polymer polysaccharide hemostatic hydrogel, which is to be analyzed in more details on a larger sample of patients.

Keywords

• peptic ulcer
• gastroduodenal bleeding
• endoscopic hemostasis