IMPROVING TREATMENT TACTICS FOR PATIENTS WITH GASTRODUODENAL ULCERATIVE BLEEDING

Abstract

Relevance. The purpose of the study is to evaluate the clinical results of treatment of patients with gastroduodenal bleeding with active endoscopic tactics. Material and methods. We analyzed the results of treatment of 191 patients with gastroduodenal bleeding of non-variceal etiology who were treated at the State Budgetary Institution of the Republic of Dagestan Republican Clinical Hospital of Emergency Medical Care (Makhachkala) from 2017 to 2023. The age of the patients ranged from 26 to 78 years, men – 98 (51.3%) and women – 93 (48.7%). In case of acute gastroduodenal bleeding, there was a history of use of alcoholic beverages in 75 (18.3%) of the studied patients, and non-steroidal anti-inflammatory drugs in 42 (22%). Upon admission and endoscopy, patients were divided into two groups with a high and low risk of gastroduodenal bleeding. Patients at low risk of bleeding were <60 years of age; without low hemodynamic disturbances and hemoglobin not lower than 70 g/l. Results. The high-risk group included 56 (29.3%) patients, and the low-risk group included 135 (70.7%) patients. Both groups were dominated by men. Comorbidities (p<0.01) and nonsteroidal anti-inflammatory drug (NSAID) use (p<0.01) were more frequent in the high-risk group. Gastric ulcer was the cause of bleeding in 90 (47.1%) compared with duodenal ulcer observed in 101 (52.9%). However, bleeding-related mortality in the very elderly group was greater than 8% (14.3%) vs 6% (4.4%; p=0.02). In multivariate analysis, only shock on admission was independently associated with mortality (p =0.02).With the active implementation of a multidisciplinary approach in the surgical department, out of 191 patients with profuse bleeding Forrest IA, IIB, 8 (4.2%) patients were operated on, including 4 with recurrent bleeding. Mortality after surgical treatment from 8 operated on in 2 (25%) patients. After endovascular hemostasis, out of 19 patients, mortality was found in 1 (5.3%) patients, and after combined hemostasis out of 164 – in 5 (3%) people. Conclusion. A multidisciplinary approach to the treatment of acute gastroduodenal bleeding gives positive results. The use of prophylactic and therapeutic transarterial embolization is feasible in patients with OGDC, when the risk after endoscopic hemostasis is high. For recurrent bleeding, endovascular hemostasis should be the preferred method in elderly comorbid patients for whom surgery is an undesirable treatment option.