ANALYSIS OF RECURRENT BLEEDING IN THE SURGICAL TREATMENT OF COMPLICATIONS OF PEPTIC ULCER DISEASE AND PORTAL HYPERTENSION USING PEROXIDE HEMOSTASIS
Main Article Content
Abstract
The aim of the study was to analyze the causes and features of recurrence of upper gastrointestinal bleeding when using the technology of peroxide hemostasis in the surgical treatment of complications of peptic ulcer and portal hypertension.
Methods and materials. Retrospective analysis of 410 medical records of patients admitted with signs of upper gastrointestinal bleeding to the general surgery department and subjected to endoscopic hemostasis in 2019-2021. Endoscopy was performed within an hour of admission. The main way to stop bleeding was submucosal infiltration of 1 % H2O2 solution 10-30 ml. The clinic of bleeding recurrence, endoscopic findings at recurrence and repeated endoscopy, the number of recurrences, the need for surgical hemostasis, treatment outcomes were taken into account.
Results. The overall rebleeding rate was 7 %. There were four main sources of recurrent bleeding: chronic peptic ulcers of the stomach and duodenum bulb, esophageal varices and mucosal tears in Mellory-Weiss syndrome. Chronic peptic ulcers of the stomach and duodenum bulb were the most unfavorable in terms of recurrence rate. The recurrence rate of variceal bleeding was practically unchanged over the years of follow-up. Recurrences in 84 % of cases were noted in case of gastric ulcer diameter more than 1 cm. On the contrary, in case of duodenum bulb ulcers, half of recurrences occurred when the ulcer diameter was up to 1 cm. Vessel localization in the fundus was noted in all cases of recurrent bleeding. There was also an absolute predominance of men in recurrent bleeding. With recurrent bleeding after the second hemostasis and at the third rebleeding one out of 12 patients with peptic ulcer was operated on (8 %). Variceal bleeding recurred in 5 of 106 patients (5 %).
Conclusion. Regular use of peroxide hemostasis in the treatment of upper gastrointestinal bleeding can significantly reduce the proportion of rebleeding, the need for surgical hemostasis, and overall mortality.
Downloads
Article Details
Section
Author Biographies
Алексей Григорьевич Короткевич, Federal State Budgetary Educational Institution of Further Professional Education "Russian Medical Academy of Continuous Professional Education" of the Ministry of Healthcare of the Russian Federation, Novokuznetsk
MD, professor
Professor, Department of Surgery, Urology, Endoscopy and Pediatric Surgery
Илья Васильевич Савостьянов, Novokuznetsk State Institute for Postgraduate Medical Education; Novokuznetsk City Clinical Hospital N 29 named after A.A. Lutsik, Novokuznetsk
candidate of medical sciences, assistant of the department of surgery, urology, endoscopy and pediatric surgery; doctor of the department of endoscopyАнтон Сергеевич Леонтьев, Novokuznetsk State Institute for Postgraduate Medical Education; Novokuznetsk City Clinical Hospital N 29 named after A.A. Lutsik, Novokuznetsk
doctor of medical sciences, professor of the department of surgery, urology, endoscopy and pediatric surgery; doctor of the department of endoscopyИнна Сергеевна Шестак, Novokuznetsk City Clinical Hospital N 29 named after A.A. Lutsik
candidate of medical sciences, doctor of the department of endoscopyСемен Александрович Май, Novokuznetsk City Clinical Hospital N 29 named after A.A. Lutsik
doctor of the endoscopy departmentЯна Ярославовна Маринич, Novokuznetsk City Clinical Hospital N 29 named after A.A. Lutsik
candidate of medical sciences, doctor of the department of endoscopyReferences
Klein A, Gralnek IM. Acute, nonvariceal upper gastrointestinal bleed-ing//CurrOpinCrit Care. 2015.21(2). 154-62.doi: 10.1097/MCC.0000000000000185
Han YJ, Cha JM, Park JH, Jeon JW, Shin HP, Joo KR, Lee JI.Successful Endoscopic Hemostasis Is a Protective Factor for Rebleeding and Mortality in Patients with Nonvariceal Upper Gastrointestinal Bleeding//Dig Dis Sci. 2016 Jul;61(7):2011-8.doi: 10.1007/s10620-016-4082-9
Nam JH, Jeon TJ, Cho JH, Kim JH. Risk factors of the rebleeding ac-cording to the patterns of nonvariceal upper gastrointestinal bleed-ing//Turk J Gastroenterol. 2017. 28(4). 266-271. doi: 10.5152/tjg.2017.17066
Jimеnez-Rosales R, Martinez-Cara JG, Vadillo-Calles F, Ortega-Suazo EJ, Abellan-Alfocea P, Redondo-Cerezo E. Analysis of rebleeding in cases of an upper gastrointestinal bleed in a single center series// Rev EspEnferm Dig 2019. 111(3).182-188.doi: 10.17235/reed.2018.5702/2018
Čustović N, Saray A, Ćato-Mehmedbašić S, Tančica I, Sprečkić S, Tokić N, Herenda N. Characteristics of Patients with Nonvariceal Upper Gastrointestinal Bleeding - Are We Underestimating Gastroprotection during NSAIDs Therapy?// Acta Med Acad. 2021. 50(2). 244-251. doi: 10.5644/ama2006-124.340
Boros E, Sipos Z, Hegyi P, Teutsch B, Frim L, Váncsa S, Kiss S, Dem-brovszky F,Oštarijaš E, Shawyer A, Erőss B. Prophylactic transcatheter arterial embolization reducesrebleeding in non-variceal upper gastrointes-tinal bleeding: A meta-analysis//World JGastroenterol 2021. 27(40). 6985-6999.doi: 10.3748/wjg.v27.i40.6985
Martínez-Alcalá A, Mönkemüller K.Emerging Endoscopic Treatments for Nonvariceal Upper Gastrointestinal Hemorrhage// GastrointestEn-doscClin N Am. 2018. 28(3). 307-320.doi: 10.1016/j.giec.2018.02.004
Falcão D, Alves da Silva J, Pereira Guedes T, Garrido M, Novo I, Pedroto I. The Current Portrayal of Non-Variceal Upper Gastrointestin-al Bleeding in a Portuguese Tertiary Center//GE Port J Gastroenterol. 2021. 28(6). 392-397. doi: 10.1159/000516139
Mille M., Engelhardt T., Stier A. Bleeding Duodenal Ulcer: Strategies in High-Risk Ulcers// Visc Med. 2021. 37. 52–62.doi: 10.1159/000513689
Barkun AN, Adam V, Wong RCK.Use of Doppler Probe in Nonvariceal Upper-Gastrointestinal Bleeding Is Less Costly and More Effective Than Standard of Care//ClinGastroenterolHepatol. 2019 Nov;17(12):2463-2470. doi: 10.1016/j.cgh.2019.02.016
Cai JX, Saltzman JR. Initial Assessment, Risk Stratification, and Early Management of Acute Nonvariceal Upper Gastrointestinal Hemorr-hage//GastrointestEndoscClin N Am. 2018 Jul;28(3):261-275.doi: 10.1016/j.giec.2018.02.001
Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, Leontiadis GI, Abraham NS, Calvet X, Chan FKL, Douketis J, Enns R, Gralnek IM, Jairath V, Jensen D, Lau J, Lip GYH, Loffroy R, Maluf-Filho F, Meltzer AC, Reddy N, Saltzman JR, Marshall JK, Bardou M. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group//Ann Intern Med. 2019.3.171(11). 805-822. doi: 10.7326/M19-1795
Schweizer U, Grund KE, Fundel J, Wichmann D, Königsrainer A. [Treatment of nonvariceal upper gastrointestinal bleeding: endoluminal-endovascular-surgical]//Chirurg. 2019. 90(8). 607-613. doi: 10.1007/s00104-019-0948-7
KimJ.S., Lee I.S. Role of surgery in gastrointestinal bleeding// Gastroin-testinal Intervention. 2018. 7(3). 136-141. DOI:10.18528/gii180029
Arslan E, Ozakin E, Temel T, Ozakyol AH, Acar N, Kaya FB, Canakci ME, Caglayan T. Early Endoscopy Decrease the Length of Hospital Stay and the Costs in Patients with Upper Gastrointestinal Bleeding//Niger J ClinPract. 2021.24(8). 1211-1216. doi: 10.4103/njcp.njcp_424_20
Kim J.S., Kim B.W., Kim D.H., ParkC.H., LeeH., JooM.K., JungD.H., ChungJ.W., Choi H.S., Baik G.H., Lee J.H., Song K.Y., Hur S. Guidelines for Nonvariceal Upper Gastrointestinal Bleeding// Gut and Liver. Vol. 14 No. 5 2020 pp. 560-570. doi: 10.5009/gnl20154
Marmo R, Soncini M, Bucci C, Occhipinti V, Pellegrini L, Zullo A. Derivation and validation of Re.Co.De death score risk in patients with acute nonvariceal upper GI bleeding; GISED Study Group// GastrointestEndosc. 2022.-.1-8.doi: 10.1016/j.gie.2022.01.024
Aluizio CLS, Montes CG, Reis GFSR, Nagasako CK. Risk stratification in acute variceal bleeding: Far from an ideal score//Clinics (Sao Paulo). 2021. 28. 76:e2921. doi: 10.6061/clinics/2021/e2921
Rout G, Sharma S, Gunjan D, Kedia S, Nayak B, Shalimar. Comparison of various prognostic scores in variceal and non-variceal upper gastrointestinal bleeding: A prospective cohort study//Indian J Gastroenterol. 2019. 38(2). 158-166. doi: 10.1007/s12664-018-0928-8
El Hajj W, Quentin V, BoudouxD'Hautefeuille G, Vandamme H, Berger C, Moussaoui MR, Berete A, Louvel D, Bertolino JG, Cuillerier E, Thiebault Q, Arondel Y, Grimbert S, Le Guillou B, Borel I, Lahmek P, Nahon S. Prognosis of variceal and non-variceal upper gastrointestinal bleeding in already hospitalised patients: Results from a French prospective cohort; ANGH for the SANGHRIA Study Group//United European Gastroenterol J. 2021.9(6). 707-717. doi: 10.1002/ueg2.12096
Kim MS, Moon HS, Kwon IS, Park JH, Kim JS, Kang SH, Sung JK, Lee ES, Kim SH, Lee BS, Jeong HY. Validation of a new risk score system for non-variceal upper gastrointestinal bleeding//BMC Gastroenterol. 2020. 17. 20(1). 193. doi: 10.1186/s12876-020-01346-4
Gralnek IM, Stanley AJ, Morris AJ, Camus M, Lau J, Lanas A, Laursen SB, Radaelli F, Papanikolaou IS, CúrdiaGonçalves T, Dinis-Ribeiro M, Awadie H, Braun G, de Groot N, Udd M, Sanchez-Yague A, Neeman Z, van Hooft JE. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021//Endoscopy. 2021. 53(3). 300-332. doi: 10.1055/a-1369-5274
Fujishiro M, Iguchi M, Kakushima N, Kato M, Sakata Y, Hoteya S, Ka-taoka M, Shimaoka S, Yahagi N, Fujimoto K. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding//Dig Endosc. 2016. 28(4). 363-378. doi: 10.1111/den.12639
Mullady D.K, Wang A.Y., Waschke K.A. AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review//Gastroenterology. 2020. 159(3). 1120-1128. doi: 10.1053/j.gastro.2020.05.095
Laine L., Barkun A.N., Saltzman J.R., Martel M., Leontiadis G.I. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding// Am J Gastroenterol. 2021. 116. 899–917. doi: 10.14309/ajg.0000000000001245
Sey MSL, Mohammed SB, Brahmania M, Singh S, Kahan BC, Jairath V. Comparative outcomes in patients with ulcer- vs non-ulcer-related acute upper gastrointestinal bleeding in the United Kingdom: a nationwide cohort of 4474 patients//Aliment PharmacolTher. 2019 Mar;49(5):537-545. doi: 10.1111/apt.15092
Park S.J., Park H., Lee Y.C., Choi C.H., Jeon T.J., Park J.C., Kim J.H., Youn Y.H., Kim Y.J. , Kim J.H., Lee K.J., Lim S.G., Kim H., Bang B.W. Effect of scheduled second-look endoscopy on peptic ulc-er bleeding: a prospective randomized multicenter trial// GastrointestEn-dosc. 2018. 87. 457-465. doi: 10.1016/j.gie.2017.07.024
Kamal F., Khan M.A., Lee-Smith W., Sharma S., Imam Z., Henry C., Jowhar D., Khan Z., Petryna E., Iqbal U., Tombazzi C., Ismail M.K, Howden C.W. Role of routine second-look endoscopy in patients with acute peptic ulcer bleeding: meta-analysis of randomized controlled trials//GastrointestEndosc. 2021.93.1228-37.doi: 10.1016/j.gie.2020.12.039
Лаврешин П.М., Бруснев Л.А., Горбунков В.Я., Волостников Е.В., Эбзеев А.Х., Ефимов А.В., Жерносенко А.О. Опыт лечения гастро-дуоденальных кровотечений язвенной этиологии в условиях город-ской больницы// Вестник Национального медико-хирургического Центра им. Н.И. Пирогова 2019. т. 14. № 2. С.42 – 44. DOI: 10.25881/BPNMSC.2019.55.29.009
Lavreshin P.M., Brusnev L.A., GorbunkovV.Ya., Volostnikov E.V., EbzeevA.Kh., Efimov A.V., Zhernosenko A.O. Experience in the treatment of gastroduodenal bleeding of ulcerative etiology in a city hospital // Bulletin of the National Medical and Surgical Center. N.I. Pirogov 2019. Vol. 14. No. 2. P. 42 - 44. DOI: 10.25881/BPNMSC.2019.55.29.009
Zullo A, Soncini M, Bucci C, Marmo R;GruppoItaliano per lo Studio dell'EmorragiaDigestiva (GISED) (Appendix).Clinical outcomes in cirr-hotics with varicealor nonvariceal gastrointestinal bleeding: A prospec-tive, multicenter cohort study//J GastroenterolHepatol. 2021. 36 (11).3219-3223.doi: 10.1016/j.gie.2022.01.024