ENDOSCOPIC METHODS OF HAEMOSTASIS IN GASTRODUODENAL BLEEDING

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Abstract

The modern endoscopic methods of treatment of gastroduodenal bleedings as well as the statistical data for 2015-2022 conducted in the Republican Scientific Center for Emergency Medical Care Andijan branch, patients with gastroduodenal bleedings and endoscopic methods of treatment used in the hospital are presented in the paper. In this article 1404 patients with the clinical picture of gastroduodenal bleedings were investigated and of them endoscopic intervention was carried out in all patients, with endohaemostasis in 97 patients.

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35

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

35-41

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

ABSTRACT

The modern endoscopic methods of treatment of gastroduodenal bleedings as well as the statistical data for 2015-
2022 conducted in the Republican Scientific Center for Emergency Medical Care Andijan branch, patients with
gastroduodenal bleedings and endoscopic methods of treatment used in the hospital are presented in the paper. In
this article 1404 patients with the clinical picture of gastroduodenal bleedings were investigated and of them
endoscopic intervention was carried out in all patients, with endohaemostasis in 97 patients.

KEYWORDS

Gastroduodenal bleeding, haemostasis, coagulation, application, endoscopic haemostasis.

Research Article


ENDOSCOPIC METHODS OF HAEMOSTASIS IN GASTRODUODENAL
BLEEDING

Submission Date:

February 27, 2022,

Accepted Date:

March 17, 2022,

Published Date:

March 29, 2022 |

Crossref doi:

https://doi.org/10.37547/TAJMSPR/Volume04Issue03-07


Gulomidin Minhodjievich Khodjimatov

MD, Professor, Chair Of General Surgery, Fibroendoscopy And Anesthesiology Resuscitation Andijan State
Medical Institute, Uzbekistan

Dilshodbek Mamadalievich Hakimov

MD, Associate Professor, Chair Of General Surgery Anesthesiology-Resuscitation And Fibroendoscopy
Department Andijan State Medical Institute, Uzbekistan

Bekzodbek Bakhodirovich Karaboev

Assistant Of The Department Of General Surgery Fibroendoscopy And Anesthesiology-Resuscitation
Andijan State Medical Institute, Uzbekistan

Khabibullo Khamdamovich Khamdamov

Candidate Of Medical Sciences, Associate Professor Of General Surgery Fibroendoscopy And
Anesthesiology-Resuscitation Department Andijan State Medical Institute, Uzbekistan

Nosirbek Adhamovich Kasimov

Assistant Of The Department Of General Surgery Fibroendoscopy And Anaesthesiology-Resuscitation
Andijan State Medical Institute, Uzbekistan



Journal

Website:

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rnals.com/index.php/ta
jmspr

Copyright:

Original

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may be used under the
terms of the creative
commons

attributes

4.0 licence.


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36

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

35-41

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

INTRODUCTION

Gastric bleeding is a pressing problem in emergency
surgery today. Rapid pace of life, stress, irregular and
low-quality diet, uncontrolled intake of nonsteroidal
anti-inflammatory drugs, peptic ulcer, and common
vomiting can lead to such dangerous complications.
The fatality rate for gastroduodenal bleeding is about
6%. To date, the main role in the successful treatment
of patients with gastrointestinal bleeding plays an early
and accurate diagnosis of the cause of bleeding,
adequate conservative therapy, and surgical treatment
if ineffective. Esophagogastroduodenoscopy (EGDS) is
the main method of diagnosing the local cause of
bleeding from the upper digestive tract and the
modern method of hemostasis. Analysis of the causes
of adverse outcomes shows that one of the directions
in improving the results of treatment of such patients
is the improvement of methods of nonoperative
haemostasis and prediction of the risk of recurrent
bleeding .

EGD tasks in patients with upper gastrointestinal
haemorrhage:

1.

Determine the localization of the source of
bleeding;

2.

Determine its main characteristics;

3.

Determine whether the bleeding is ongoing
(assess its intensity) or whether it is ongoing;

4.

Endoscopic hemostasis in case of ongoing
bleeding:

Final or temporary (as a preparatory step for
surgery);

Prognosis and prevention of recurrence in cases of
existing bleeding:

Final haemostasis or temporary (as a measure to
prevent recurrence of bleeding in preparation for
surgery).

Indications for endoscopic haemostasis:

1) ongoing bleeding at the time of endoscopic

examination (gastroscopy, EGDS) -Forrest I for
ulcerative bleeding;

a) ongoing arterial jet bleeding -Forrest I - occurs in 8-

10% of patients, of whom 80-85% have a risk of
potential recurrence;

b) ongoing capillary bleeding in the form of diffuse

oozing - Forrest Ib - occurs in 10-15% of patients. The
risk of recurrence in the latter is 5%;

2) bleeding that has stopped at the time of endoscopic

examination with stigmas in the fundus or margins
of the source - Forrest II - occurs in 25-40% of
patients. Of these, there is a risk of potential
recurrence in 40-50%;

a) a clot tightly fixed to the ulcer crater - Forrest IIb -

occurs in 15-20% of patients, of whom there is a risk
of recurrent bleeding in 40-50%;
b) small thrombosed vessels in the form of dark
brown spots -Forrest IIc - occur in 10% of patients, of
whom 5% are at risk of recurrent bleeding.


Indications for endoscopic hemostasis during dynamic
EGDS:

1)

negative dynamics of the bleeding source,
consisting in the preservation of intact previously
"treated" vascular structures, the manifestation of
new vessels or the development of recurrent
bleeding (repeated endoscopic hemostasis is
performed if the patient is not subject to
emergency surgery for recurrence);

2)

detection of a vascular arch in close proximity
(<1mm) to the bottom of the ulcerous defect by
endoscopic ultrasonography.


Endoscopic examination makes it possible to identify
the source of bleeding, to answer the question


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Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

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03

Pages:

35-41

SJIF

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MPACT

FACTOR

(2020:

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(2021:

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64

)

(2022:

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)

OCLC

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METADATA

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Publisher:

The USA Journals

whether the bleeding has stopped or continues, and to
carry out and monitor the effectiveness of treatment
measures.


Contraindications for endoscopic haemostasis:

1.

Endoscopic haemostasis is not indicated in
patients who are in an extremely severe
(agonal) state, in whom it is dangerous to
perform the endoscopic examination itself,
gastroscopy.

2.

The presence of perforation and bleeding
from an ulcer or tumour, if the diagnosis of
hollow organ perforation is not in doubt.

3.

Do not try to stop bleeding, especially with
diathermy or laser treatment, if the source of
bleeding cannot be clearly seen, which may
be due to either the anatomical features of
the organ (severe deformity or stenosis) or a
massive inflow of blood flooding the source
or the endoscopic viewing window, as is
more commonly seen in arterial bleeding
from a duodenal ulcer.

4.

Danger of perforation. This applies especially
to bleeding from the bottom of deep gastric
and duodenal ulcers (anterior wall) and deep
mucosal tears of the proximal stomach and
oesophageal-gastric junction area.

5.

Acute

myocardial

infarction,

cerebral

circulatory disorder considered by the
majority of researchers as contraindication
both

for diagnostic and therapeutic

esophagogastroduodenoscopy in a planned
or emergency procedure, under modern
technical equipment (endoscopes with thin
external

diameter)

cannot

be

contraindication to therapeutic endoscopy at
gastrointestinal bleedings.


Methods of endoscopic hemostasis:


Various methods, differing in their physical properties
and mechanisms of action, are used to influence the
source of bleeding through the endoscope.Currently,
according to the domestic literature, the following
methods of endoscopic hemostasis are most
commonly used:
1.

Thermal: electrocoagulation, thermo-cautery,
laser

photocoagulation,

argon-plasma

coagulation (due to thrombosis of the vessel in
the bleeding area);

2.

Injection: adrenaline (vasoconstriction); alcohol,
sclerosants (chemical coagulation + dehydration);
cyanoacrylates, thrombin, fibrin glue (adhesive
filling);

3.

Mechanical: clipping, ligation (ligation of the
vessel and the source of bleeding).


The selection of the arsenal of techniques depends
primarily on their clinical results, and if this is equal, on
the ratio: efficiency/ease of performance + safety/cost
+ availability. Therapeutic endoscopy at acute
gastrointestinal bleedings as a whole possesses rather
high efficiency and allows: to carry out temporary or
final hemostasis at the overwhelming majority of
patients and adequately prepare them for urgent
operative intervention;

In combination with modern drug therapy it makes
it possible to prevent a recurrence of bleeding and
postpone the operation to the stage of elective
surgery;

monitoring and repeated haemostasis in patients
with marginal anaesthetic risk when emergency
surgery cannot be performed.


Diathermic coagulation:

is the most versatile, highly

effective method of endoscopic hemostasis. Mono-, bi-
, and multipolar coagulation of the bleeding source
with high frequency current is used, resulting in rapid


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38

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

35-41

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

heating and eventually thrombosis of the bleeding
vessel and/or thickening of the resulting thrombus.
Clinical experience shows that monoactive coagulation
is mainly indicated for bleeding from chronic ulcers and
tumours. Biactive coagulation is preferred for bleeding
from esophageal-gastric junction mucosal tears, acute
ulcers, erosions and other lesions where there are no
marked scarring-sclerotic tissue changes and deep
coagulation is not required (or is dangerous).

Thermocauterisation:

(cauterisation

or

thermal

coagulation) is considered by many experts to be the
method of choice for hemostasis today. The active
principle of thermocauterisation is not an electric
current but rather a thermoprobe tip, which is heated
more than 100 degrees Celsius. When observing
elementary safety precautions, it does not cause deep
burns and is successfully used for almost all types of
non-variceal gastrointestinal bleeding.

Laser photocoagulation: The source of bleeding has
retreated into the background in recent years. In most
clinical situations, it has given way to similarly effective,
but significantly less costly and cumbersome, but
easier to perform and safer for the patient and staff,
methods of endoscopic hemostasis

.

Argon plasma coagulation:

One of the most important

advantages of this method is that it is non-contact and
therefore devoid of the side effects of contact
techniques, such as recurrence of bleeding due to
thrombus clot detachment. Argon plasma can be used
for hemostasis in hard-to-reach areas (e.g. in the
deformed bulb of the duodenum) due to its affinity to
areas of high conductivity (fresh blood and fresh
thrombi) and the mode of operation by "flowing
around the corner". The coagulating effect of argon
plasma is easy to dose, it has no pronounced thermal
effect on the deep layers of the intestinal wall (the

depth of penetration of argon plasma into the depth of
tissue is not more than 2-3 mm) and, therefore, safe in
terms of perforating organs, especially such as
esophagus, duodenum and small intestine.

Injection

haemostatic

with

vasoconstrictors:

mechanical compression of vessels with a liquid
solution combined with local haemostatic action and
spasm of small vessels almost always leads to
temporary stopping of bleeding or at least a reduction
in its intensity. The most commonly used method is
0.005% adrenaline solution in saline solution. The drug
is injected using an endoscopic injection needle -
paravasally from 3-4 points and into the base of the
vessel. Volume of injected solution is usually 5 to 20 ml.
Injection with ethanol. If continued bleeding is
detected during endoscopic examination and the
bleeding vessel cannot be clearly localized, a 25-30%
ethanol solution is used, which is injected into the
mucosa tear edges, edges and bottoms of ulcers,
submucosa layer in the erosion location area or tumour
tissue in an amount of 4-6 ml.


The use of adhesive filling techniques:

the source of

bleeding looks attractive, but carries with it a number
of serious drawbacks. This primarily concerns the use
of synthetic adhesive compositions, in particular
cyanoacrylates, which polymerise so rapidly and
permanently that they often lead to the failure of
expensive hardware. In addition, the infiltration of
cyanoacrylates into biological tissues leads to the
formation

of

pronounced

infiltrates,

which

significantly complicates or complicates the surgical
procedure. The widespread use of biocomposites
(particularly fibrin glue) is to some extent prevented by
its high cost and concerns about the possibility of
transmission of viral and prion infections with the drug.


Combined use of hemostasis techniques:

The most


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39

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

35-41

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

common combination in primary endoscopy is the
sequential use of injection and thermal techniques.
They complement each other and show their positive
aspects, at the same time counterbalancing the
disadvantages of each method. Overall, this makes it
possible to achieve a more effective, reliable and
permanent haemostasis.

In the clinical practice of the endoscopic office of the
Andijan branch of the RSCEEMP, taking into account
the emergency nature of work for endoscopic
haemostasis the following techniques are used:

Electrocoagulation.

Infiltration hemostasis (0.1% solution of adrenaline
hydrochloride or 70% solution of ethyl alcohol).

Film-forming polymer application (infiltration
hemostasis + application).

OBJECTIVE


To evaluate the results of endoscopic methods of
hemostasis in gastroduodenal bleeding Republican
Scientific Centre of Emergency Medical Aid Andijan
branch.

MATERIALS AND RESEARCH METHODS


Analysis of medical records of patients in the surgical
departments of the Republican Scientific Center for
Emergency Medical Care Andijan branch for the period
2015-2022 was carried out. During 7 years 1404
endoscopic interventions (FGDS) were performed in
patients with gastroduodenal bleedings, of them men-
1095 (78%) and women-309 (22%). Among sources of
bleeding there are 1107 (79%) patients with duodenal
ulcer and 297 (21%) patients with gastric ulcer. Our
centre has established an emergency endoscopy

service, which allows for therapeutic and diagnostic
endoscopy around the clock. In determining the
activity of bleeding and assessing the degree of
haemostasis, Forrest (1987) classification was
followed.

Of these: - Combined endoscopic hemostasis was
performed in 97(7%) patients, 150 (11%) patients were
operated on, conservative treatment was performed in
1157 (82%) patients.

RESULTS AND DISCUSSION


During the analysis of case histories of patients in the
surgical department of RCEMS Andijan branch with
gastroduodenal bleeding 1404 patients were examined
in 2015-2019, out of them endoscopic hemostasis was
carried out in 97 patients. Repeated endoscopic
hemostasis was performed in 3 patients.

In patients, against the background of endoscopic
haemostasis an improvement in well-being, rapid
activation, and after the complete disappearance of
the clinic of gastrointestinal bleeding the patient was
discharged earlier in comparison with other patients
with the same pathology, but without the use of
endoscopic haemostasis was noted.

CONCLUSIONS

Bleeding from the upper gastrointestinal tract remains
an acute problem in emergency surgery. The most
common causes of bleeding are gastric and duodenal
ulcers, Mellory-Weiss syndrome, bleeding from
esophageal

varices

and

malignant

tumours.

Endoscopic diagnosis of bleeding is the leading
method today. Of the endoscopic techniques the most
frequently used is the combined use of hemostasis
techniques such as diathermic coagulation, injectable


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40

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

35-41

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

hemostasis with vasoconstrictors, application of
composite polymeric material. A prospective study of
the effectiveness of endoscopic hemostasis in clinical
practice showed that the application of composite
polymeric material over the ulcerous defect helps to
reduce the recurrence of hemorrhagic syndrome,
reduce the need for surgical treatment and
respectively the mortality rate

.


REFERENCES

1.

Khakimov D.M., Karaboev B.B., Nosirov M.M.
Current trends and problems in the treatment of
gastroduodenal bleeding. // Bulletin of Tashkent
Medical Academy. 2021 №1. Pp. 85-88.

2.

DJuraev, A. M., & Khalimov, R. J. (2020). New
methods for surgical treatment of perthes disease
in children. International Journal of Psychosocial
Rehabilitation, 24(2), 301-307.

3.

Dzhuraev, A., Usmanov, Sh., Rakhmatullaev, H., &
Khalimov, R. (2021). Our experience with surgical
treatment of congenital elevation of the scapula
in young children. Medicine and Innovations, 1(4),
37-44.

4.

Dzhuraev, A. M., & Khalimov, R. D. (2012). Our
experience in the surgical treatment of Perthes
disease in children. Postgraduate Physician,
50(1.3), 377-383.

5.

Dzhuraev, A., Usmanov, Sh., Rakhmatullaev, H., &
Khalimov, R. (2021). Our experience with surgical
treatment of congenital elevation of the scapula
in young children. Medicine and Innovations, 1(4),
37-44.

6.

Stupin V.A., Siluyanov S.V., Smirnova G.O., Sobirov
M.A. Modern approaches to the treatment of
bleeding from acute ulcers of the stomach and
duodenum. // Surgery. - 2020. -№8. - C. 51-98.

7.

Stepanov Y.V., Zalewski V.I., Kosinski A.V.
Gastrointestinal bleeding. // Surgery. - 2011. - №14.
- С. 179.

8.

Bohnacker S., Sriram P.V.J., Soehendra N. The role
of endoscopic therapy in the treatment of
bleeding varices. // Bailliere's Clin Gastroenterol. -
2019. - Р. 15-130.

9.

Fedorov E.D., Mikhalev A.I., Orlov S.Y., Timofeev
M.E., Chernyakevich P.L., Plakhov R.V. Endoscopic
diagnosis and stopping of acute gastroduodenal
bleeding and prediction of risk of relapse. //
Russian journal of gastroenterology, hepatology,
coloproctology. - 2019. - №4. - С. 46.

10.

Sadykov U.S., Kyzhyrov J.N., Kapanova G.J. The
role of endoscopy in diagnosis and treatment of
bleeding from acute gastroduodenal ulcers in
clinical practice. // Bulletin of Kazakh National
Medical University. - 2012. - №1. - С. 283 - 287.

11.

Gapanovich V.N., Chumanevich O.V., Bordakov
V.N. Endoscopic methods of hemostasis in
gastrointestinal bleeding. // Med. News. -№7. -
2006. - С. 123-128.

12.

Khodjieva D.T., Pulatov S.S., Khaidarova D.K. All
about hemorrhagic stroke in elderly and senile
persons (own observations) // Science of Young
People (Eruditio Juvenium). 2015. №3. С. 87-96.

13.

MI Kamalova, S Khaminov, B Eshboltaeva
Morphometric features of bronchial epithelium
development in rabbits in postnatal ontogenesis

14.

Shomurodov. K.E. Features of cytokine balance in
gingival fluid at odontogenicphlegmon of
maxillofacial area. // Doctor-aspirant 2010.-42 Vol.-
No.5.1.-P.187-192;

15.

Ilkhomovna, K. M., Eriyigitovich, I. S., &
Kadyrovich, K. N. (2020). Morphological Features
Of Microvascular Tissue Of The Brain At
Hemorrhagic Stroke. The American Journal of
Medical Sciences and Pharmaceutical Research,
2(10),

53-59.


background image

41

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

35-41

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

https://doi.org/10.37547/TAJMSPR/Volume02Issue
10-08

16.

Khodjieva D. T., Khaydarova D. K., Khaydarov N. K.
Complex evaluation of clinical and instrumental
data for justification of optive treatment activites
in patients with resistant forms of epilepsy.
American Journal of Research. USA. № 11-12, 2018.
C.186-193.

17.

Sadriddin Sayfullaevich Pulatov. (2022). Efficacy of
ipidacrine in the recovery period of ischaemic
stroke. World Bulletin of Public Health, 7, 28-32.

18.

Tukhtarov B.E., Comparative assessment of the
biological value of average daily diets in
professional athletes of Uzbekistan. Gig. Sanit.,
2010, 2, 65–67.


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