International Journal of Biomedicine. 2021;11(1):24-28.
Originally published March 5, 2021
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.
- Budnevsky AV, Cherednikov ЕF, Popov AV, Ovsyannikov ES, Kravchenko AY, Fursov KO. A Complex Multidisciplinary Approach to Prevention Gastro-duodenal Bleeding in Patients of General Hospital. International Journal of Biomedicine. 2017; 7(3):204-207. doi: 10.21103/Article732)_OA8
- Cherednikov EF, Deryaeva OG, Adianov VV, Ovchinnikov IF, Popov AV. [Modern trends of diagnosis and treatment of patients with gastrointestinal bleeding in the centre]. System Analysis and Management in Biomedical Systems. 2014;13(2):426-431. [Article in Russian].
- Cherednikov EF, Maleev YuV, Chernyh AV, Litovkina TE, Bondarenko AA, Cherednikov EE, Popov AV. [Current views on the diagnosis, treatment, and prevention of ruptured hemorrhagic syndrome (Mallory-Weiss syndrome)]. Journal of New Medical Technologies. 2016;23(4):161-172. [Article in Russian].
- Baev VE, Kravets BB, Cherednikov EF. [Diagnostics of ulcerative forms of stomach cancer]. Voronezh. 2003: 112. [Article in Russian].
- Cherednikov EF, Maleev YuV, Chernykh AV, Litovkina TE, Cherednikov EE, Shevtsov AN. [Modern views on the etiology and pathogenesis of ruptured hemorrhagic syndrome (Mallory-Weiss syndrome)]. Journal of anatomy and histology. 2016;(1):86-98. [Article in Russian].
- Adianov VV, Cherednikov EF. [Optimization of treatment of gastroduodenal bleeding in patients with high surgical risk]. System Analysis and Management in Biomedical Systems. 2014;13(4):841-846. [Article in Russian].
- Cherednikov ЕF, Barannikov SV, Romantsov MN, Popov AV. New aspects of preventive endoscopic hemostasis in the treatment of peptic ulcer bleeding in the experimental condition. The EPMA Journal. 2017;8(S1):45.
- Deryaeva OG, Cherednikov EF. [Multimodality therapy of erosiveulcer gastroduodenal bleeding by patients in a multidisciplinary hospital]. System Analysis and Management in Biomedical Systems. 2014;13(3):725-730. [Article in Russian].
- Cherednikov EF, Barannikov SV, Zhdanov AI, Moshurov IP, Polubkova GV, Maleev YuV, Ovsyannikov ES, Myachina DS. Combimed Use of biologically Active Hemostatic and Granulated Sorbent in Endoscopic Cytoprotective Hemostasis in Patients with Bleeding Gastroduodenal Ulcers. International Journal of Biomedicine. 2020;10(2):129-132. doi: 10.21103/Article10(2)_OA8
- Cherednikov EF, Glukhov AA, Romantsov MN, Maleev YuV, Barannikov SV, Shkurina IA, Vysotskaya AT, Ovsyannikov ES. Hemostatic Agents in Combination with Diovine for Local Treatment of Simulated Bleeding Gastric Ulcers. International Journal of Biomedicine. 2020;10(2):138-141. doi: 10.21103/Article10(2)_OA10
- Cherednikov ЕF., Budnevsky AV, Popov AV, Fursov KO. A new opinion on gastroduodenal bleeding preventon in patients with somatic patology. The EPMA Journal. 2017; 8(S1): 46.
- Savelyev VS. Guide to emergency surgery of abdominal organs. Moscow: Triad-X; 2004:640 pp.
- Cherednikov EF, Barannikov SV, Fursov KO, Polubkova GV, Danilenko VI, Stepanov DS. [Healing of bleeding experimental defects of the stomach with topical anilovin and platelet-rich plasma]. Journal of Volgograd State Medical University. 2017; 2(62): 130-133. [Article in Russian].
- Romantsov MN, Cherednikov E F, Danilenko VI, Stepanov DS, Fursov K O, Deryaeva AG. [Morphological Characteristics of Processes of Simulated Bleeding Gastric Defects Reparation in Treatment with Gelplastan and Diovin]. Journal of Anatomy and Histopathology. 2017; 6(1): 81-86. [Article in Russian].
- Cherednikov EF, Barannikov SV, Maleev YuV, Fursov KO, Litovkina T E, Zakurdaev EI. [Experimental justification of the use of biologically active draining sorbent and plasma enriched by thrombocytes in treatment of bleeding defects of the stomach]. Journal of New Medical Technologies. 2017;24(2):114-118. [Article in Russian].
- Cherednikov EF, Batkaev AR, Baev VE. The Reparative regeneration of erosive-ulcerative lesions of the stomach and duodenum in the local treatment of hydrophilic granular sorbents. System Analysis and Management in Biomedical Systems. 2005; 4(2): 224-225. [Article in Russian].
- Barannikov SV, Litovkina TE, Fursov K O, Kuzmenok VA. [Experimental study of the possibility of using a biologically active draining sorbent and platelet-rich plasma in the endoscopic treatment of simulated bleeding stomach ulcers]. Postgraduate doctor. 2017; 2.1(81): 170-176. [Article in Russian].
- Cherednikov ЕF, Barannikov SV, Maleev YuV, Fursov KO,. Litovkina TE, Zakurdaev EI, Ovsyannikov ES. Experimental justification of using Aseptisorb-A and platelet-rich plasma in endoscopic treatment of mold bleeding stomach defects. International journal of biomedicine. 2017;7(4):298-301.
- Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974 Aug 17;2(7877):394-7. doi: 10.1016/s0140-6736(74)91770-x. PMID: 4136718.
- Gorbashko AI. Diagnostics and treatment of blood loss. Moscow: Meditsina. 1982: 224p.
- Cherednikov EF, Romantsov MN, Ovchinnikov IF, Glukhov AA, Adianov VA, Vysotskaya AT. [Method of endoscopic treatment of ulcerative gastroduodenal bleeding]. Patent for Invention RUS No. №2633588. Application No. 2015147321 dated 03.11.15; publ. 10.05.2017; Bulletin No. 13.[In Russian].
- Cherednikov EF, Budnevsky AV, Barannikov SV, Fursov KO, Bondarenko AA, Cherednikov EE, Volkova IV. [Method for endoscopic stopping of gastrointestinal bleeding]. Patent for Invention RUS No. 2632771. Application No. 2016148270 dated 09.12.2016; publ. 09.10.2017; Bulletin No. 28. [In Russian].
Received December 12, 2020.
Accepted December 31, 2020.
©2021 International Medical Research and Development Corporation.