Algorithm for the treatment of chronic duodenal ulcers complicated by bleeding

Introduction. Gastroduodenal ulcerative bleeding is a common complication of peptic ulcer disease and remains one of the most pressing problems of modern emergency abdominal surgery, as well as one of the leading causes of emergency hospitalization in surgical hospitals. Despite the development of endoscopic and X-ray endovascular technologies, the frequency of recurrent bleeding and postoperative mortality remain high, especially in patients with large ulcers and penetration into the head of the pancreas. A possible option for improving the treatment of patients with chronic duodenal ulcers complicated by bleeding is the use of hybrid hemostasis, which is a combination of endoscopic and X-ray endovascular intervention.
The objective was to improve the treatment results of patients with chronic duodenal ulcers complicated by bleeding by using hybrid hemostasis.
Methods and materials. A retrospective and prospective analysis of 349 patients with ulcerative duodenal bleeding was performed. A prognostic model for assessing the risk of recurrent bleeding was developed based on regression analysis of key factors (ulcer size and location, type of bleeding according to J.A. Forrest, presence of comorbid pathology, intake of anticoagulants and/or antiplatelet agents, ulcer penetration into the head of the pancreas, type of endoscopic hemostasis). Three risk groups for recurrent bleeding were formed: low, medium, high. For each risk group, a treatment strategy using hybrid hemostasis was determined. The outcomes of the retrospective and prospective groups were compared in terms of recurrence rate, mortality, and length of hospitalization.
Conclusions. The use of a treatment and diagnostic algorithm based on the assessment of the risk of recurrent bleeding using hybrid hemostasis allowed to significantly reduce the frequency of relapses (from 34.8 % to 14.5 %), mortality (from 16.8 % to 4.3 %) and the average hospital stay. Hybrid hemostasis can be an effective way to finally stop bleeding in the group of medium risk of recurrent bleeding, and in the high-risk group it can be used as preoperative preparation for surgery.

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