Abstract
Introduction. Compression hemostasis is widely used to arrest bleeding from veins of the esophagus in portal hypertension. Since it has a number of severe drawbacks, research is relevant to develop new approaches to solve this problem.The aim of the study was to provide evidence and develop a technique to arrest bleeding from varicose veins of the esophagus, which can become an alternative to compression hemostasis.Materials and methods. The key technology in the study was chemical-mechanical hemostasis – the combined esophageal vein compression and Hemoblock application. At the first stage, this technique was tested on laboratory animals - domestic pigs, since a model of the esophageal vein bleeding was formed in their bodies. At the clinical stage, chemical-mechanical hemostasis was performed in 15 patients with the recurrent esophageal vein bleeding; they made up the experimental group. The control group consisted of 15 patients subjected to compression hemostasis. The hemostatic effectiveness of the techniques and their assessment by the patients themselves were compared in the study.Results. In the experimental group, bleeding was arrested in 46.7% of cases by installing a probe for chemical-mechanical hemostasis with a 5-minute exposure. In the control group, bleeding was arrested in 66.7% of cases by installing an obturator probe with a 10- to 24-hour exposure. As patients’ survey reported, in the control group, patients experienced pain during the insertion of the obturator probe in 86.7% of cases, and 20% of patients experienced pain during the entire time the obturator probe was in the esophagus; 93.3% of patients expected an early termination of the procedure, 13.3% claimed that they would never agree to the procedure again. As patients’ survey reported, in the experimental group, 6.7% of patients experienced pain when inserting the probe for chemical-mechanical hemostasis and during the time, it remained in the body. 46.7% of patients wanted the procedure to be terminated as soon as possible. There were no patients who refused to repeat a procedure of chemical-mechanical hemostasis if required.Conclusions. The study demonstrated that a modified conventional obturator probe, which allowed combining compression of the esophageal veins with the hemostatic drug effect, resulted in a significantly increased hemostatic effect in case of the esophageal vein bleeding. During the study, this technique prevented 46.7% of patients from the need to use an obturator probe. Since the obturator probe, when applied, causes a large number of troublesome and painful sensations (a fact reported by 93.3% of patients), even its partial elimination can be considered as an option improving the quality of the treatment.