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Эндоскопия/Колопроктология
THE FIRST EXPERIENCE OF CLINICAL APPLICATION OF A
HAEMOBLOCK, A HAEMOSTATIC AGENT, IN ENDOSCOPIC
HEMOSTASIS
HAEMOBLOCK, A HAEMOSTATIC AGENT, IN ENDOSCOPIC
HEMOSTASIS
А. А. Polyantsev,
E. V. Kaplunova,
S.Karpenko,
A. M. Linchenko
E. V. Kaplunova,
S.Karpenko,
A. M. Linchenko
Relevance
Nowadays, the endoscopic method plays a leading role in the diagnosis and treatment of gastrointestinal bleeding. The most practical significance is the choice of therapeutic tactics for peptic ulcer disease of the stomach and duodenum, erosive hemorrhagic gastritis and Mallory- Weiss syndrome, occurring respectively in 23.0-74.4%,
11.2-33.0% and 0, 15-6.04% of observations. Surgical intervention in patients with severe conditions and the presence of severe concomitant pathology is not always safe and often leads to unsatisfactory treatment results. The overall lethality with ulcerous
gastroduodenal bleeding (GDB) is 4-8%, and postoperative mortality in the most severe forms of bleeding can reach 33%. The main factor worsening the results of treatment
of ulcer bleeding is the occurrence of a relapse, postoperative lethality which can reach 50%. Despite advances in the diagnosis and treatment of the Mallory- Weiss syndrome, the expansion of the arsenal of tools and surgical interventions, the success of anesthesiology and resuscitation, the overall mortality in this pathology remains constant for several years and ranges from 5 to 10%, and the number of recurrent bleeding - from 20 to 35%. These data call for the search for reliable and minimally invasive methods for stopping bleeding. Unfortunately, the possibilities of endoscopic hemostasis are limited, which is due to the peculiarity of the source of bleeding (vessel diameter, blood flow intensity, localization), inadequate physician experience, difficulty in choosing the hemostatic method, inadequate technical equipment of the endoscopic department, and inefficiency of conservative treatment. Currently, the following methods of endohemostasis are usually used: injection, clipping, ligation of blood vessels, thermocoagulation. In diffuse haemorrhages, multipolar or argon-plasma coagulation is preferred. However, they do not reduce the risk of late recurrence of bleeding [3]. Also, the drawbacks of these methods include difficulties in their use in the inaccessible localization of the source of bleeding. The simplest endoscopic method of influencing bleeding zones is their irrigation with haemostatic drugs, the interaction of which with blood forms a blood clot tightly fixed to the organ wall (caprofer). This method is effective with continued capillary and stopped bleeding. At present, a new topical hemostatic Haemoblock is being introduced into practical use, which includes an incomplete salt of polyacrylic acid and silver nanoparticles. When interacting with blood albumins Haemoblock forms a polymer complex, resulting in hemostasis.
Nowadays, the endoscopic method plays a leading role in the diagnosis and treatment of gastrointestinal bleeding. The most practical significance is the choice of therapeutic tactics for peptic ulcer disease of the stomach and duodenum, erosive hemorrhagic gastritis and Mallory- Weiss syndrome, occurring respectively in 23.0-74.4%,
11.2-33.0% and 0, 15-6.04% of observations. Surgical intervention in patients with severe conditions and the presence of severe concomitant pathology is not always safe and often leads to unsatisfactory treatment results. The overall lethality with ulcerous
gastroduodenal bleeding (GDB) is 4-8%, and postoperative mortality in the most severe forms of bleeding can reach 33%. The main factor worsening the results of treatment
of ulcer bleeding is the occurrence of a relapse, postoperative lethality which can reach 50%. Despite advances in the diagnosis and treatment of the Mallory- Weiss syndrome, the expansion of the arsenal of tools and surgical interventions, the success of anesthesiology and resuscitation, the overall mortality in this pathology remains constant for several years and ranges from 5 to 10%, and the number of recurrent bleeding - from 20 to 35%. These data call for the search for reliable and minimally invasive methods for stopping bleeding. Unfortunately, the possibilities of endoscopic hemostasis are limited, which is due to the peculiarity of the source of bleeding (vessel diameter, blood flow intensity, localization), inadequate physician experience, difficulty in choosing the hemostatic method, inadequate technical equipment of the endoscopic department, and inefficiency of conservative treatment. Currently, the following methods of endohemostasis are usually used: injection, clipping, ligation of blood vessels, thermocoagulation. In diffuse haemorrhages, multipolar or argon-plasma coagulation is preferred. However, they do not reduce the risk of late recurrence of bleeding [3]. Also, the drawbacks of these methods include difficulties in their use in the inaccessible localization of the source of bleeding. The simplest endoscopic method of influencing bleeding zones is their irrigation with haemostatic drugs, the interaction of which with blood forms a blood clot tightly fixed to the organ wall (caprofer). This method is effective with continued capillary and stopped bleeding. At present, a new topical hemostatic Haemoblock is being introduced into practical use, which includes an incomplete salt of polyacrylic acid and silver nanoparticles. When interacting with blood albumins Haemoblock forms a polymer complex, resulting in hemostasis.
Work objective
Improving the results of treatment of patients with gastroduodenal bleeding by using the Haemoblock.
Improving the results of treatment of patients with gastroduodenal bleeding by using the Haemoblock.
Study methods
Irrigation with the Haemoblock solution was performed in patients hospitalized in the surgical department of the General Surgery Clinic in March-April 2015 with continuing and completed bleeding Ib, IIa and IIb according to Forrest classification from erosive and ulcerative defects of the gastroduodenal mucosa area and with the Mallory-Weiss syndrome. To stop bleeding or to prevent its recurrence, the bleeding area was irrigated with Haemoblock solution through a catheter inserted into the endoscope instrumental channel in an amount of 10-20 ml. The therapeutic effect of Haemoblock was assessed visually: After 1-2 minutes, with an ongoing bleeding, an elastic smooth clot of blood was formed. With bleeding, it was used in the presence of fresh loose blood clots, as a result, a discoloration and a decrease in the size of the clots due to their compression were observed. This method of hemostasis was tested in 20 patients, of which 14 were men, and 6 women aged 25-67.
Irrigation with the Haemoblock solution was performed in patients hospitalized in the surgical department of the General Surgery Clinic in March-April 2015 with continuing and completed bleeding Ib, IIa and IIb according to Forrest classification from erosive and ulcerative defects of the gastroduodenal mucosa area and with the Mallory-Weiss syndrome. To stop bleeding or to prevent its recurrence, the bleeding area was irrigated with Haemoblock solution through a catheter inserted into the endoscope instrumental channel in an amount of 10-20 ml. The therapeutic effect of Haemoblock was assessed visually: After 1-2 minutes, with an ongoing bleeding, an elastic smooth clot of blood was formed. With bleeding, it was used in the presence of fresh loose blood clots, as a result, a discoloration and a decrease in the size of the clots due to their compression were observed. This method of hemostasis was tested in 20 patients, of which 14 were men, and 6 women aged 25-67.
Results of the research and their discussion
The characteristics of bleeding sources and the results of the application of Haemoblock are presented in Table. As can be seen from the data of Table, only in 3 cases of the use of Haemoblock, a reccurence of bleeding was observed. In 1 observation with continued bleeding, surgical treatment was required in the volume of stomach resection, and in 2 cases the hemostasis was provided by repeated application of Haemoblock solution 6 hours after the initial irrigation. 17 patients showed reliable hemostasis.
The characteristics of bleeding sources and the results of the application of Haemoblock are presented in Table. As can be seen from the data of Table, only in 3 cases of the use of Haemoblock, a reccurence of bleeding was observed. In 1 observation with continued bleeding, surgical treatment was required in the volume of stomach resection, and in 2 cases the hemostasis was provided by repeated application of Haemoblock solution 6 hours after the initial irrigation. 17 patients showed reliable hemostasis.
Medical report
Thus, in most cases, Haemoblock haemostatic provides reliable hemostasis with the most common sources of bleeding from the upper sections of the gastrointestinal tract. The use of this hemostatic is possible without additional use of other methods of endoscopic hemostasis. The effectiveness of Haemoblock solution should be studied in prospective studies.
Thus, in most cases, Haemoblock haemostatic provides reliable hemostasis with the most common sources of bleeding from the upper sections of the gastrointestinal tract. The use of this hemostatic is possible without additional use of other methods of endoscopic hemostasis. The effectiveness of Haemoblock solution should be studied in prospective studies.