The Use of the Hemostatic Agent Zhelplastan in Combination with a Granulated Sorbent in the Treatment of Patients with Mallory-Weiss Syndrome

Abstract

Background: Mallory-Weiss syndrome (MWS) is one of the common causes of acute upper gastrointestinal bleeding. The aim of our research was to develop a method for the treatment of MWS, which would improve the efficiency of local hemostasis, reduce the risk of re-bleeding and shorten the treatment time. Methods and Results: The study involved 102 patients with MWS. All patients were divided by random sampling into two groups: the main group (MG) and control group (CG). Patients of both groups were comparable in age, gender, concomitant diseases, type of bleeding, size of bleeding defect, and duration of observations. The MG included 52 patients, who were given the developed method of MWS treatment. Patients with ongoing bleeding were treated with a combined method of endoscopic hemostasis: active bleeding was initially stopped by infiltration or coagulation (argon-plasma coagulation was preferred), and then to increase the reliability of hemostasis and prevent the resumption of bleeding, powdered Zhelplastan 0.2g was applied to the rupture area with an insufflator, followed by Sephadex G-25 0.3g (Patent RF №2633925). In patients with signs of unstable hemostasis, the developed method of cytoprotective action on a clot or thrombosed vessel was used by applying a local hemostatic, Zhelplastan 0.2g, to the defect area in combination with a granular sorbent, Sephadex G-25 0.3g, during therapeutic endoscopy to prevent the resumption of bleeding. In patients with stable stopped bleeding, a hemostatic powdered Zhelplastan was applied to the defect area using an endoscope in combination with Sephadex G-25, according to the developed method. In the CG (n=50), well-known methods of arresting endoscopic bleeding (pricking with aminocaproic acid, vasoconstrictors, argon-plasma coagulation, etc.) were used without local hemostatics and granular sorbents. Summing up the results of patients with Mallory-Weiss syndrome in the compared groups, in the MG final hemostasis was performed in 51(98.1%) patients. In the MG, bleeding resumed in 1(1.9%) patient. There were no emergency operations or deaths. In the CG, the bleeding was finally stopped in 43(86%) patients, and it resumed in 7(14%) patients. Emergency surgery was required for 1(2%) patient. In the CG, the mortality rate was 4%. Conclusion: In MWS, the use of the developed method of endoscopic treatment, including pneumoinsufflation of a powdered hemostatic agent in combination with a granular sorbent, against the background of conservative therapy, improved the results of treatment, increased the reliability of local hemostasis, reduced the number of recurrent bleedings, and excluded emergency operations.

Keywords

• mallory-weiss syndrome
• endoscopic treatment
• zhelplastan
• sephadex g-25