INFLUENCE OF TYPE 2 DIABETES ON THE EFFICIENCY OF ENDOSCOPIC HEMOSTASIS FOR BLEEDING FROM PEPTIC GASTRODUODENAL ULCER

Abstract

Abstract. One of the most progressive methods of treatment of gastroduodenal bleeding in peptic ulcers of the stomach and duodenum is endoscopic hemostasis (EH), which is relatively safe and highly effective. Endoscopic hemostasis in gastroduodenal ulcer bleeding is achieved in more than 90% of cases. This procedure is recommended for bleeding caused by peptic ulcers of the stomach and duodenum, as a first-line method with relatively high efficiency and a small number of complications, but it is inferior to surgical methods in terms of the number of recurrences of bleeding. The aim: analysis of EH results in patients with gastroduodenal bleeding against the background of comorbid diabetes. Materials and methods. 834 patients with gastroduodenal ulcer bleeding were under observation. The average age of the patients was (51.4±0.54) years, duration of disease manifestation – (5.3±0.28) years, duration of bleeding – (46.3±1.49) hours, diameter and volume of gastric ulcer – (1.3±0.05) mm and (510.4±47.13) mm3, and duodenal ulcers — (0.8±0.01) mm and (164.5±7.34) mm3, the value of the ulcer severity index (WI) — (5.9±0,07) c. u., bleeding severity index (BI) – (2.1±0.03) points, average blood pressure parameters – (98.8±0.66) mmHg, glycemia indicators (Gl) – (10.0±0.26) mmol/l, glycosylated hemoglobin (HbA1/c) – (8.2±0.20)%, insulin (Ins) – (24.9±1.36) μIU/ml, coefficient of the degree of insulin resistance (NOMA) – (11.8±0.81) in. at. The ratio of mild, moderate and severe type 2 diabetes was 1:2:1. EH was performed on 283 (97.9%) patients on the background of hemostatic drug therapy, who were the main observation group. The comparison group included 551 patients who received only similar medical treatment. EH was performed in 92.2% of cases with the injection of a 0.9% solution of sodium chloride, adrenaline, alcohol-novocaine mixture, clipping, coagulation, and in 7.8% with the use of N-butyl-2 spraying in the edges of the ulcer - acrylate. The results. Within 1 month after carrying out endoscopic and drug hemostasis, recurrence of gastroduodenal bleeding was detected in 12.9% of cases, and half as often with EH (respectively in 7.9% and 15.9% of observations in the main group and the comparison group χ 2 =11, 58, p=0.001). The effectiveness of the use of EH is higher compared to separate isolated hemostatic therapy, as evidenced by the 60-hour survival rates in the main group (cumulative proportion 0.98) and in the comparison group (cumulative proportion 0.91). It should be noted that comorbid diabetes reduces the survival of patients with gastrointestinal bleeding during these observation periods.