Endoscopic treatment of peptic ulcer disease

Endoscopic treatment of peptic ulcer disease is used as an addition to drug therapy for ulcers that are difficult to treat.

Reasons for delayed ulcer healing.

1. Large size of ulcer defect.
2. Overhanging edges.
3. Presence of sclerotic fibrous margin.
4. Accumulation of decay products in the ulcer cavity.
5. The absence of an inflammatory reaction around the ulcer is evidence of low regenerative capacity of the surrounding tissues.
6. High acidity of gastric juice.

Objectives of endoscopic treatment.

1. Stimulation of ulcer epithelialization or scarring.
2. Relief of pain.
3. Elimination of periulcer inflammation.
4. Decreased level of gastric secretion.
5. Elimination and prevention of complications.

Indications for endoscopic treatment.

1. Ulcers up to 2.5 cm in diameter and no more than 0.5 cm in depth when conventional conservative treatment is unsuccessful.
2. Ulcers with the presence of local factors that delay scarring.
3. Ulcers that require surgical treatment if the patient refuses surgery or if there are contraindications to surgical intervention.

Contraindications to endoscopic treatment.

1. Malignancy of the ulcer.
2. The localization of the ulcerative defect is inconvenient for endoscopic manipulations.
3. The presence of complications requiring surgical treatment.
4. The patient's serious condition due to the presence of concomitant diseases.
5. The presence of factors that make it difficult to insert an endoscope into the stomach.
6. Negative attitude of the patient towards therapeutic endoscopy. All contraindications are relative.

Necessary medications.

1. Antibiotics.
2. Antiseptics (furacilin, rivanol, etc.)
3. Oils (sea buckthorn, rose hips, etc.)
4. Hormonal drugs.
5. Ethanol.
6. Atropine solution.
7. Novocaine solution.
8. Adhesive preparations.
9. Solcoseryl.
10. Oxyferriscorbone.
11. Astringents, anti-inflammatory agents (collargol, protargol, tannin).

Other drugs are also used that improve tissue regeneration or promote the rejection of necrotic areas (Kalanchoe juice, enzymes, antioxidants, leukocyte mass, etc.)

Local anti-inflammatory treatment is carried out independently or in combination with conservative treatment. Local anesthesia is used. Local treatment includes therapeutic and surgical methods. Surgical methods include various interventions performed with instruments inserted through the endoscope channel. Therapeutic methods include local drug therapy.

Local treatment methods.

1. Removal of necrotic masses and fibrin from ulcers.
2. Elimination of sclerotic fibrous margin.
3. Administration of antibiotics to suppress the activity of microflora in the peri-ulcer zone.
4. Injection of drugs that restore tissue vitality.
5. Local administration of medicinal products that stimulate tissue regeneration. Inject from 2-3 points, 5-6 mm from the edge.
6. Application of substances that protect the ulcer surface from the harmful effects of the environment. When applying film-forming polymers, the diameter and depth of the mucosal defect decreases, which accelerates epithelialization. The use of film-forming substances promotes ulcer healing without the formation of pronounced scars. Ulcers are completely epithelialized, either leaving no trace or forming delicate linear or stellate scars that practically do not protrude above the surface of the mucosa.
7. Nerve blockade. Conducted once every 2 days.
8. Blockade of vagal trunks along. Add 2.0 ml of 70-degree alcohol and 2.0 ml of 0.1% atropine solution to 50 ml of novocaine. Inject into the area of the cardioesophageal junction from 2 points once every 2 weeks.
9. Stretching of areas of the digestive tract that are stenotic due to cicatricial or inflammatory processes.

In all cases, complex local therapy is used. One method is replaced by another depending on the changes in the ulcer.

Sequence of procedures.

During an endoscopic examination, decay products are removed mechanically or hydraulically. Overhanging edges are excised with forceps and coagulated. Solcoseryl solution is injected into the ulcer edge. If granulation occurs, oxyferriscorbone is injected instead of solcoseryl and oil and glue applications are performed. In case of "clean" ulcers, the sclerotic edge is excised and glue is applied to the ulcer. Pain is eliminated with novocaine blockades. Treatment sessions are performed daily or every other day. If there is no effect after 10 sessions, endoscopic treatment is canceled.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]