The results of using endovascular methods for stopping ulcerative gastroduodenal bleeding

Abstract

This article presents the results of treatment of patients with ulcerative gastroduodenal bleeding who were treated in the 2^nd clinic (surgery for the improvement of doctors) Military Medical Academy at the I.I. Dzhanelidze Research Institute of Emergency Medicine. A retrospective analysis was conducted of the frequency of rebleeding, surgical activity and mortality in groups with the use of transcatheter arterial embolization with and without it. The criteria for inclusion in the study were: the presence of ulcerative gastroduodenal bleeding, confirmed by laboratory and instrumental methods of examination, severe general somatic condition of patients. The comparison was carried out in the main and control groups. The main group consisted of 20 patients who underwent endovascular hemostasis. The control group included 46 patients without the use of X-ray surgical methods. The average age of patients in the main and control groups was 65.5 ± 3.7 and 60.7 ± 3.9 years. In both groups, most patients were admitted later than 24 hours after the onset of the disease and with severe blood loss. The severity of the somatic state of the intervention was assessed according to the APACHE II multiple organ failure assessment scale, according to which, patients in the main group were somatically more severe than in the control group. In the groups, bleeding from stomach ulcers prevailed (up to 75%). Most often, endovascular hemostasis is performed at a high risk of recurrent bleeding, and adhesive compositions and spirals were used as an embolizing agent. Angiography revealed direct or indirect signs of bleeding (extravasation, hypervascularization, aneurysmal dilatation) in 12 cases, and preventive embolization was performed in 8 cases. In 70% of cases, the source of bleeding was the left gastric artery. In the control group, recurrent bleeding and surgical activity accounted for 26%. In the main group, 20% and 15%, respectively. In the main group, recurrent bleeding occurred in 4 cases, 1 patient underwent repeated endoscopic hemostasis, 3 patients underwent open surgical interventions. All 4 patients had a fatal outcome, against the background of massive blood loss and aggravated somatic pathology. The overall mortality rate in the control group was 44%, in the main group 35%. Transcatheter arterial embolization did not significantly improve the results of treatment of ulcerative gastroduodenal bleeding due to the severity of the general somatic condition of the patients included in the study.

Keywords

transcatheter arterial embolization / ulcer gastrointestinal bleeding / extravasation / adhesive composition / recurrent bleeding

References

[1] Acute upper gastrointestinal bleeding: management. National Institute for Health and clinical Excellence. London: Royal College of Physicians; 2012.

[2] Acute upper gastrointestinal bleeding: management // National Institute for Health and clinical Excellence. London: Royal College of Physicians, 2012.

[3] Yazvennye gastroduodenal’nye krovotecheniya. Natsional’nye klinicheskie rekomendatsii. Rossiiskoe obshchestvo khirurgov. Moscow; Voronezh; 2014. (In Russ.)

[4] Язвенные гастродуоденальные кровотечения. Национальные клинические рекомендации / Российское общество хирургов. М.; Воронеж, 2014.

[5] Loffroy R, Guiu B, Cercueil JP, Krausé D. Endovascular therapeutic embolization: anoverview of occluding agents and their effects on embolised tissues. Curr Vasc Pharmacol. 2009;7(2):250–263. DOI: 10.2174/157016109787455617

[6] Loffroy R., Guiu B., Cercueil J.P., Krausé D. Endovascular therapeutic embolization: anoverview of occluding agents and their effects on embolised tissues // Curr. Vasc. Pharmacol. 2009. Vol. 7, No. 2. P. 250–263. DOI: 10.2174/157016109787455617

[7] Protocols of diagnostics and treatment of acute surgical diseases of bodies of an abdominal cavity. St. Petersburg research institute of Emergency Care of I.I. Dzhanelidze. 3rd ed. Saint Petersburg; 2017. (In Russ.)

[8] Протоколы диагностики и лечения острых хирургических заболеваний органов брюшной полости / Санкт Петербургский научно-исследовательский институт скорой помощи им. И.И. Джанелидзе. 3-е изд. СПб., 2017.

RIGHTS & PERMISSIONS

Sinenchenko G.I., Verbitskiy V.G., Demko A.E., Sekeyev A.N., Alentyev S.A., Kiselev M., Parfenov A.O., Alimov P.A.