A method of endoscopic hemostasis in peptic ulcer bleeding gastroduodenal

 

(57) Abstract:

The invention relates to medicine, in particular in gastroenterology. The method provides a reduction in the time of the procedure when conducting fibrogastroduodenoscopy through the use of a small amount of hemostatic solution, reducing postinjection complications. Impose solutions containing 5% ascorbic acid into the submucosal space in the region of the ulcer, while imposing a 1% solution of hydrogen peroxide by volume of 10-40 ml combined with 2 ml of ascorbic acid and the introduction is repeated every 8-12 hours until the formation of local stable hemostasis.

The invention relates to the field of endoscopy and can be used to stop bleeding from gastroduodenal ulcers.

Treatment of patients with gastroduodenal ulcer bleeding includes, in addition to conducting conventional hemostatic therapy, endoscopic hemostasis. The currently used methods of endoscopic hemostasis is based mainly on mechanical, pharmacoeconomics and electrothermal mechanisms of local exposure to the source of bleeding. Most rasprostranjenim bleeding defect in the lining of the stomach or duodenum by means of the injector, conducted through the channel of the endoscope, are various hemostatic solutions.

As hemostatic solutions during endoscopic hemostasis using epinephrine 0.1% in the amount of 1 ml, dissolved in 10 ml of physiological solution. Entered once, subsequent injections with the resumption of bleeding (G. A. Valenzuela, D. McGroarty, E. Pizzani, Devis T. Jr//Va Med, 1989, Dec, 116(12), R. 507-509).

But using a solution of epinephrine in 30-40% of patients have ineffective hemostasis, early recurrence of bleeding, necrosis at the injection of the drug with the formation of acute ulcers and erosions.

It is also known about the application of 0.5-1% solution of ethoxysilane, which is injected into the wall of the body next to a bleeding vessel in the amount of 2 ml once (J. Panes, Forne, F. Bagena, J. Viver//Am J Gastroenterol, 1990 Mar; 85(3), p. 252-254).

Injection of this solution can lead to the development of complications such as uncontrolled necrosis of the wall of the stomach, duodenum and adjacent organs (liver, pancreas), recurrence of bleeding from ulcers after rejection of necrotic scab, bleeding from the newly formed acute ulcers and erosions in the injection of sclerosant.

Bolelli amounts of 5-40% glucose solution, 5% solution of ascorbic acid and 5% solution epsilonematidae acid, which have a reparative properties and restore regional metabolic homeostasis. Solutions imposed in podlesice-muscular layer of the wall of the body near ulcerative defect in the amount of from 20 to 2000 ml or more. Subsequently, if necessary, the introduction of a solution repeat every 6-12 hours the first day, then once a day to obtain a stable local hemostasis (L. J. Cimen et al. "Medical consultation, 2001, No. 1, pp. 10-26).

The disadvantages of this method: for a long time hemostasis due to the introduction of a large number of hemostatic solutions, when using these solutions is possible, though less likely, the formation of necrosis of the walls of the body in the injection of hemostatic solution with the formation of acute erosions and ulcers, which themselves can be the source of the bleeding.

The objective of the invention is to reduce the time of the procedure when conducting fibrogastroduodenoscopy (FGDs) through the use of a small amount of hemostatic solution, reducing postinjection complications due to the absence of destruction of the walls of the body at the injection geostatical hydrogen peroxide by volume of 10-40 ml in combination with a 5% solution of ascorbic acid in a volume of 2 ml. The procedure is repeated every 8-12 hours until the formation of local stable hemostasis.

The novelty of the method consists in the introduction:

1. 1% solution of hydrogen peroxide by volume of 10-40 ml;

2. 5% ascorbic acid solution volume of 2 ml.

Ascorbic acid (vitamin C) is a white crystalline powder sour taste, is involved in the formation of the basic substance of connective tissue and collagen synthesis, regulation of blood coagulation, normalizes capillary permeability. In medical practice ascorbic acid is used for profilaktiki and treatment With vitamin deficiency, bleeding of various etiologies, in low regenerative processes. Hydrogen peroxide is the oxidant, the principle of its action consists in the liberation of molecular oxygen upon contact with acids and proteins of the body. Using a 3% solution of hydrogen peroxide as an antiseptic, externally for the treatment of purulent wounds. In addition, the hydrogen peroxide helps to stop bleeding (Kharkevich D. A. Pharmacology. - M.: Medicine - 87, pp. 366-367, 405; Mashkovsky M. D. "Drug". - M.: Medicine - 72, volume II, page 28, 440).

Not currently aware of the space on the periphery of the ulcer 1% solution of hydrogen peroxide leads to rapid decomposition of hydrogen peroxide with the release of molecular oxygen and saturation them interstitial space, the creation of a zone of high pressure, which leads to compression of the bleeding vessel and quickly stop bleeding. The presence of excess oxygen reduces tissue hypoxia in the area of the bleeding, thus preventing the formation of new defects mucous in the injection solution.

The essence of the proposed method

For endoscopic hemostasis patient perform gastroduodenoscopy through a biopsy channel of gastroduodenoscopy is the injector and into the submucosal space near the source of bleeding is introduced 10-40 ml of 1% hydrogen peroxide solution and 2 ml of 5% ascorbic acid solution. The observed pattern is characterized by the fact that the mucous in the injection rises, turns bright pink. The bleeding stops after the first few ml. In the future, at endoscopic control at the injection site is visible unchanged mucosa. The emergence of new mucosal defects in the injection solutions are not marked. Infusion repeated every 8-12 hours until signs of local stable hemostasis. It is used to stop bleeding and for preventive GE who I am. According to FGDs, in the cardiac Department of the stomach along the lesser curvature of ethics ulcer up to 5 cm, in the region of its visible bleeding vessel. Through injector made the introduction into the submucosal space near the vessel 1% hydrogen peroxide solution 40 ml + 2 ml of 5% ascorbic acid solution. The bleeding stopped. Control fibrogastroduodenoscopy after 9 hours in the injection solution, the mucous is not changed, the bottom of the ulcer is covered by fibrin, no blood. Discharged for treatment in a specialized Department.

Clinical example 2. The patient is 50 years old hospitalized with a diagnosis of XP. ulcer of the gastric body, complicated by bleeding. During FGDs, in the stomach of old and fresh blood. Ulcerative defect up to 1.5 cm in diameter is located on the border of the fundus and the body on the back wall of the stomach, in the bottom of the ulcer is visible thrombosed vessel. Performed endoscopic hemostasis introduction into the submucosal space near the vessel 20 ml of 1% hydrogen peroxide solution + 2 ml of 5% ascorbic acid solution. Control endoscopic examination performed after 8 hours, signs of rebleeding no, still visible thrombosed vessel. In the introduction hemostatic solution mucosa is not changed. Repeated submucosal introduction the C 10 hours, ulcerative defect covered by fibrin, no blood evidence. In the injection mucosa pink, smooth, new mucosal defects during the inspection were not found. The patient performed elective gastrectomy. Recovery.

Clinical example No. 3. The patient is 30 years old was admitted with clinical signs of gastrointestinal bleeding. When fibrogastroduodenoscopy in the antrum of the stomach detected acute ulcer to 0.7 cm in diameter, diffuse bleeding from the edges of the ulcer. Endoscopic hemostasis introduction into the submucosal space near the mucosal defect 10 ml of 1% hydrogen peroxide solution and 2 ml of 5% ascorbic acid solution, the bleeding stopped. Endoscopic control after 12 hours, the bottom of the ulcer is covered by a red clot, with the aim of preventive hemostasis repeated submucosal introduction hemostatic solution in the same volume. When viewed through 9 hours the bottom of the ulcer is covered by hemosiderin conducted preventive hemostasis introduction of the same amount of hemostatic solution. Control endoscopic examination conducted after 10 hours, the ulcer is covered with fibrin at the site of injection of hemostatic solutions mucosa pink, without defects. Discharged from vittoro is all patients achieved endoscopic hemostasis, defects mucous in the injection solutions are not noted in any patient.

A method of endoscopic hemostasis in peptic ulcer bleeding gastroduodenal zone by injecting solutions containing 5% ascorbic acid into the submucosal space in the region of the ulcer, characterized in that impose a 1% solution of hydrogen peroxide by volume of 10-40 ml combined with 2 ml of ascorbic acid, while the introduction is repeated every 8-12 h prior to the formation of local stable hemostasis.

 

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