Materials and methods of study
The study was carried out on 205 patients who were removed 396 polyps of the stomach.
Polyps were solitary and multiple.. Endoscopic polypectomy included preoperative preparation, endoscopic surgery and postoperative control. Endoscopic removal of polyps was carried out by electrocoagulation and electroexcision with OLYMPUS electrosurgical unit PSD-10. The electrocoagulation method used a diathermic probe, and a forceps for "hot biopsy". With the method of electroexcision, the polyp was cut off by a diathermic loop, thrown over the stem or base of the polyp, in the mode of "cutting" - "coagulation". For the capture and extraction of cut polyps, biopsy forceps, diathermic loop, Dormia baskets, extractors, trap devices of various companies were used. For injections and irrigation - disposable
and reusable endoscopic injectors and catheters of various manufacturers.
The patients were divided into two groups. The main group consisted of 63 persons, to whom 129 polyps were removed. The drug Haemoblockinjected into the base of the polyp to patients of the main group before removal of polyps of the stomach. Through the injector, 3 to 10 ml of the drug was injected into the base of the polyp until a distinct cushion was formed. In the group there were 19 men and 44 women, aged 30 to 85 years, according to the age groups, the patients were distributed as follows: 30-44 years old -1, 45-59 years old - 9, 60 -74 years old - 46, more than 75 years old -7, the average age was 65.5 ± 2.0 years. The polyps had the following localization: in the body of the stomach: t/ 3 -13, m/ 3-23, b/ 3 -37, antral section -56. , ........ on the front wall was located 28, the back one - 26, small curvature - 13, large one - 62. The size of the polyps was: from
0.5 to 1 cm -60, up to 1.5 cm -37, up to 2.0 cm -13, up to 3 cm -11, up to 4.0 cm 5, more than 4 cm - 3. 92 polyps had the stem, wide base - 37 ones. Among the polyps, hyperplastic formations predominated, in the main group there were 82, adenomas - 47.
With the submucosal introduction of Haemoblock, the hydraulic compression of the vessels of the polyp base was accompanied by an increase in local thrombogenesis. After the creation of the "cushion", the polyp was removed by electroexcision or coagulation using a standard procedure. After removal of the polyp to prevent possible bleeding, irrigate and/ or split the bed of the removed polyp. With the development of bleeding, the irrigation and/ or stabbing of the hemorrhage source by means of the Haemoblock was also performed. Irrigation was carried out using a proprietary spray catheter or a conventional catheter inserted into the biopsy endoscope channel. A source of blood circulation was sprayed from top to bottom in small portions using 50 to 100 ml of the drug. To enhance hemostasis, the endoptotic injection site of the remote polyp bed was used. The needle of the endoscopic injector, conducted through the biopsy channel of the endoscope, was punctured to the maximum depth in the zone of electrosurgical intervention in 2 -3 mm from the source of bleeding alternately from 5 to 6 points. Through the injector, the drug was injected into the organ wall until a distinct swelling roller was formed around the source of the bleeding. The control group consisted of 142 persons, to whom 267 polyps were removed. In the group there were 50 men and 92 women, according to the age groups, the patients were distributed as follows: 30 - 44 years old - 6, 45 - 59 years old - 34, 60 - 74 years old - 85, more than 75 years old - 17, the average age was 64.2 ± 1.6 years. The polyps had the following localization: in the body of
the stomach: t/ 3 -33, m/ 3-46, b/ 3 -65, antral section -123. , ........ on the front wall there were 78, the back one - 60, small curvature - 22, large one - 107. The size of the polyps was: from 0.5 to 1 cm -113, up to 1.5 cm -78, up to 2.0 cm -32, up to 3 cm -29, up to 4.0 cm 10, more than 4 cm - 5. 174 polyps, had the stem, wide base - 37 ones. In the control group, the hyperplastic formations over the adenomatous ones also predominated, respectively: 158 and 109. Patients of the control group were followed by the same methods of electrocoagulation and electroexcision without using the Haemoblok hemostat. To create a cushion, Novocain, saline solution, aminocaproic acid solution were used. To prevent bleeding after polypectomy, injection method and electrocoagulation were used. Patients of both groups had no significant differences in sex, age, age distribution, gastric location, size, mean size and number of removed polyps.
Patients of the main and control groups with bleeding had moderate bleeding. Comparative evaluation of the methods took into account the following indicators: the occurrence of bleeding from a thermal defect, the achievement of the final stop of bleeding, the recurrence of bleeding from a thermal defect.