[Influence of the incidence of ulcerative gastroduodenal bleeding on the effectiveness of treatment. Statistical surveillance]

[Damage control strategy in surgical treatment of patients with severe gastroduodenal bleeding]

OBJECTIVE/

To objectify patient condition and improve treatment outcomes in patients with benign severe gastroduodenal bleeding.

MATERIAL AND METHODS

We analyzed the immediate results of staged surgical treatment of patients with benign severe gastroduodenal bleeding according to the accepted concept of «Damage Control Surgery». The Rockall risk scoring system and the Glasgow-Blatchford score (GBS) were used. We preferred two-stage intervention in patients with Rockall score ≥5 and Glasgow-Blatchford score ≥11.

RESULTS

Staged approach according to the concept of «Damage Control Surgery» in patients with benign severe gastroduodenal bleeding ensures positive results by minimizing surgical trauma and perioperative bleeding, early stabilization of hemostasis and subsequent successful restoration of digestive function.

CONCLUSION

The concept of «Damage Control Surgery» in patients with benign severe gastroduodenal bleeding can reduce mortality and incidence of postoperative complications.

Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding: A case series analysis observational study

Peptic ulcer disease accounts for 50% to 70% of acute upper gastrointestinal bleeding cases. There is no consensus on the treatment of peptic ulcer bleeding (PUB) using endoscopic techniques. This study aimed to compare endoscopic techniques for PUB.Patients with PUB who were hospitalized between January 2014 and June 2020 were included in this study. They were divided into 3 groups: endoclip and low-dose epinephrine injection (0-2 mg, Group 1, n = 62), endoclip and high-dose epinephrine injection (2-4 mg, Group 2, n = 54), and endoclip only (Group 3, n = 64).Early bleeding and permanent hemostasis were higher in Group 2 (P = .014, .035). When evaluated in terms of late hemostasis and urgent surgical need, there was no significant difference between the groups (P > .05). Group 2 received a higher amount of blood. Thirty-day mortality occurred in 16.5%, 22.2%, and 9.4% of patients in Groups 1, 2, and 3, respectively. Group 2 had a longer hospital stay than Groups 1 and 3 (P = .008). The endoscopic success rates were 80.6%, 72.2%, and 90.6% in Groups 1, 2, and 3, respectively.In PUB, if the patient's Rockall score is high and the ulcer size is larger than 2 cm, endoclip application can be used as the main treatment. Addition of epinephrine may be considered when necessary.