Hybrid technologies for treating gastroduodenal ulcerative bleeding in patients with severe comorbidity index

The purpose of the study is to improve the immediate treatment outcomes of patients with recurrent gastroduodenal ulcerative bleeding and severe comorbidity index. Materials and methods. A comparative analysis of the immediate results of treatment of 2 groups of patients aged 43 to 86 years with recurrent gastroduodenal ulcerative bleeding and severe comorbidity index was performed. The first group consisted of 57 patients with recurrent gastroduodenal ulcerative bleeding after combined endoscopic hemostasis, who were treated using repeated endoscopic and conventional surgical techniques. Gastric ulcer was detected in 21 (38%) and duodenal ulcer in 31 (62%) patients. The second group consisted of 76 patients with recurrent gastroduodenal ulcerative bleeding after combined endoscopic hemostasis, who were treated with repeated endoscopic techniques and endovascular hemostasis methods. The source of bleeding was gastric ulcer in 28 (40%) and duodenal ulcer in 42 (60%) patients. Depending on the source of bleeding, combined endoscopic hemostasis was performed in both groups, the first-line therapy of which was injection therapy in a volume of 30-40 ml (epinephrine diluted in saline solution at 1:10000), supplemented by monopolar or argon plasma coagulation or vessel clipping. Age, gender, severity of blood loss, and comorbidity index were comparable in both groups (p>0.05). Results. An integrated approach to the treatment of patients with severe comorbidity index and gastroduodenal ulcerative bleeding with the combined use of endoscopic and endovascular techniques for stopping bleeding proved to be a highly reliable (p<0.001) and effective way to achieve final hemostasis. Conclusion. In patients with severe comorbidity index and gastroduodenal ulcerative bleeding, there was a significant decrease in the frequency of relapses and mortality with the employment of the complex hemostasis method.