Authors
Lavreshin P.M.1, Brusnev L.A.1, Gorbunkov V.Ya.2, Volostnikov E.V.3, Ebzeev A.Kh.3, Efimov А.V.4, Zhernosenko А.О.4
1 Stavropol state medical university, Stavropol
2 Stavropol state medical university, Stavropol
3 City Clinical Hospital № 2, Stavropol
4 City Clinical Hospital № 3, Tuapse
Abstract
Objective. to analyze the result of treatment of gastroduodenal bleeding of the ulcerative etiology in the conditions of the city hospital and to determine the most effective treatment tactics.
Methods. In the period 2015–2018, in the surgical department «City Clinical Hospital № 2», Stavropol. 292 patients with acute ulcerative gastroduodenal bleeding were treated. In the study group, 169 patients (58%) prevailed among men – 123 patients (42%) compared with women. The average age is 48±7.3 years.
Results. On admission, all patients underwent esophagogastroduodenoscopy. Distribution of the source of bleeding by localization: antrum of the stomach 140 patients (48%), duodenal bulb 105 patients (36%), cardial department of the stomach 47 patients (16%). Forrest classification: Ia – 50 patients (17%); Ib – 67 patients (23%); IIa – 64 patients (22%), IIb – 96 patients (33%), IIc –15 patients (5%). Using conservative treatment only, it was possible to stop the bleeding in 172 patients (59%). When detecting continued bleeding (117 patients), patients underwent endoscopic hemostasis: injecting the bleeding vessel with a 0.01% adrenaline solution – 71 cases (60%) and argon plasma coagulation - 46 cases (40%). After endoscopic hemostasis, recurrence of bleeding was diagnosed only after injections of 0,01% adrenaline in 9 patients (7.5%). Surgical activity was 6.8%. Twenty patients received surgical treatment: gastrectomy of 6 patients, in 14 patients gastrotomy with flashing of a bleeding vessel. Mortality rate was 4.1% (12 patients).
Conclusion. 1. Endoscopic examination allows to determine the tactics of treating a patient with gastroduodenal bleeding and monitor the effectiveness of hemostasis. 2. The most effective option for endoscopic hemostasis is argon plasma coagulation. 3. Patients with gastric ulcer and duodenal ulcer require a multidisciplinary approach to treatment with regular seasonal supervision by a gastroenterologist.
Keywords: gastroduodenal bleeding, hemostasis, endoscopy, peptic ulcer.
References
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