Analysis of the results of treatment for patients with ulcerative gastroduodenal bleeding from large and giant ulcers at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Objective - to analyze the results of treatment for patients with ulcerative gastroduodenal bleeding (UGDB) from large and giant chronic ulcers to clarify the tactics of surgical treatment of this category of patients. Materials and methods. A study was conducted on the treatment results of 140 patients with UGDB out of 518 patients who were inpatient treatment at the Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine in 2018-2021. The main objectives of the examination of patients with UGDB were: clinical assessment of the patient's condition, identification of the source of bleeding, determination of the severity of blood loss and the risk of recurrence. The risk stratification of recurrent bleeding and adverse outcome was assessed according to the T.A. Rockall scale (1996). The study included elderly patients (average age was 66.8±7.3 years) with high comorbidity (Charlson2 comorbidity index 6.8±2.3) and blood loss of more than 30% of the circulating blood volume. Results. The overall mortality rate in the study group (n-140) was 15.1%. Among patients with severe and extremely severe blood loss, it was significantly higher - 20.8%. Recurrence of bleeding after TAE was noted in 13.3% of cases, after surgical treatment in 3.3% of cases and in 20% of cases in patients undergoing conservative therapy.Conclusion. Despite the changed paradigm of care for patients with UGDB towards conservative therapy, according to the literature, according to the data obtained, we came to the conclusion that in the group of patients with large and giant ulcers, the effectiveness of endoscopic hemostasis is reduced due to the size of the ulcerative defect and the comorbid background. This is evidenced by the high proportion of patients with recurrent bleeding after endoscopic hemostasis. Therefore, for this group of patients, it is necessary to adhere to certain algorithms that are based on assessing the risks of recurrent bleeding and an individual approach to choosing treatment tactics based on the severity of the patient's condition, while respecting the principle: treat not the disease, but the patient.

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