ПЕРСОНАЛІЗОВАНИЙ ЕНДОСКОПІЧНИЙ ГЕМОСТАЗ ІЗ ЗАСТОСУВАННЯМ КЛІПС OTSC ПРИ КРОВОТЕЧАХ ІЗ ГАСТРОДУОДЕНАЛЬНИХ ВИРАЗОК ВИСОКОГО РИЗИКУ: ПРОСПЕКТИВНЕ ДОСЛІДЖЕННЯ

Acute gastroduodenal ulcer (GDU) bleeding in patients with severe comorbidities remains associated with high risks of recurrence and mortality. Objective. To evaluate the efficacy of a personalized endoscopic hemostasis algorithm combining epinephrine injection and Over-The-Scope Clip (OTSC) placement in patients with high-risk gastroduodenal ulcers, and to identify clinical, immunological, and immunogenetic factors associated with a complicated disease course. Materials and Methods. The study cohort comprised 972 patients with gastroduodenal ulcer bleeding treated at the surgical departments of the Bukhara branch of the Republican Research Center for Emergency Medical Care (2016–2026), including a retrospective analysis of 510 patients (2016–2019) and 268 patients (2019–2022), alongside a prospective study of 140 patients (2024–2026). A distinct prospective cohort included 54 patients presenting with active gastroduodenal bleeding (Forrest Ia–IIb) and at least one severe comorbidity (Child-Pugh B/C liver cirrhosis, stage G4–G5 chronic kidney disease, cardiovascular disease, or anticoagulant therapy), all of whom underwent personalized hemostasis with OTSC clips. A prognostic scale, the GDK risk index, was developed and validated. Immunological assessments were conducted in 34 patients, whereas immunogenetic analyses (evaluating PTPN11, ADH2, and ALDH2 polymorphisms, alongside Helicobacter pylori CagA seropositivity) were performed in 95 patients with peptic ulcer disease, compared with 42 patients presenting with other conditions and 60 healthy controls. Statistical analysis utilized Fisher’s exact test and receiver operating characteristic (ROC) curve analysis, with statistical significance defined as p < 0.05. The study was conducted in adherence to the principles of the Declaration of Helsinki of the World Medical Association (2013 revision). The study protocol received approval from the local bioethics committee of the Bukhara State Medical Institute. All participants provided written informed consent prior to initiation of the study. Statistical analysis utilized Fisher’s exact test and receiver operating characteristic (ROC) curve analysis, with statistical significance defined as p < 0.05. The study was conducted in adherence to the principles of the Declaration of Helsinki of the World Medical Association (2013 revision). The study protocol received approval from the local bioethics committee of the Bukhara State Medical Institute. All participants provided written informed consent prior to initiation of the study. This research was supported by the scientific research plan of the Bukhara State Medical Institute under the project titled 'Improvement of Diagnostic and Minimally Invasive Treatment Methods for Gastroduodenal Bleeding in High-Risk Patients' (2022–2026). Results. Primary endoscopic hemostasis utilizing OTSC clips was achieved in 96.3% of patients (52/54). Bleeding recurrence was observed in 1.9% (1/54) of cases, contrasting with 17.7% in the historical control group (p < 0.001). The rate of surgical interventions decreased from 16.9% to 3.7% (p < 0.01), accompanied by a reduction in in-hospital mortality from 3.8% to 1.2% (p < 0.05). The GDK risk index demonstrated high prognostic accuracy for predicting bleeding recurrence (area under the curve [AUC] 0.89). Patients presenting with active bleeding exhibited secondary immunodeficiency, characterized by a significant reduction in total lymphocyte counts, CD3+ and CD4+ cell populations, and the CD4/CD8 immunoregulatory index (decreasing from 1.86 ± 0.06 to 1.40 ± 0.065; p < 0.05), concurrent with an elevation in CD20+ cell levels. Seroprevalence for cagA-positive Helicobacter pylori strains among patients with peptic ulcer disease reached 93.7%, compared with 71.4–81.7% in the control groups; nevertheless, no significant association was identified between PTPN11 (intron 3, intron 10), ADH2, or ALDH2 polymorphisms and peptic ulcer disease. Conclusions. The application of personalized endoscopic hemostasis utilizing OTSC clips in patients with high-risk gastroduodenal ulcers significantly improves immediate treatment outcomes. Implementing an active, individualized therapeutic strategy reduces overall mortality from 3.8% to 1.2% and decreases bleeding recurrence rates from 8.1% to 4.4% (p < 0.05). Immunological and immunogenetic analyses corroborate the critical role of secondary immunodeficiency and H. pylori (cagA) infection in the pathogenesis of complicated gastroduodenal ulcer disease.