Endoscopic treatment of peptic ulcer

Endoscopic treatment of peptic ulcer is used as an addition to the ongoing drug therapy for poorly treatable ulcers.

The causes of delayed scarring of ulcers.

1. Large size of ulcerative defect.
2. Overhanging edges.
3. The presence of a sclerotized fibrous margin.
4. The accumulation of decay products in the cavity of the ulcer.
5. The absence of an inflammatory reaction around the ulcer as evidence of low regenerative capacity of surrounding tissues.
6. High acidity of gastric juice.

Problems of endoscopic treatment.

1. Stimulation of epithelialization or scarring of the ulcer.
2. Withdrawal of pain syndrome.
3. Elimination of periulcerous inflammation.
4. Decreased level of gastric secretion.
5. Elimination and prevention of complications.

Indications for endoscopic treatment.

1. Ulcers with a diameter of up to 2.5 cm and a depth of no more than 0.5 cm if the conventional conservative treatment is unsuccessful.
2. Ulcers with local factors delaying scarring.
3. Ulcers subject to surgical treatment, if the patient refuses to perform the operation or if there are contraindications to an operation.

Contraindications to endoscopic treatment.

1. Malignancy of the ulcer.
2. Localization of ulcerative defect, inconvenient for carrying out endoscopic manipulations.
3. Presence of complications requiring surgical treatment.
4. Severe condition of the patient due to the presence of concomitant diseases.
5. The presence of factors that make it difficult to hold the endoscope in the stomach.
6. Negative attitude of the patient to therapeutic endoscopy. All contraindications are relative.

Necessary medicines.

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

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

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

Methods of local treatment.

1. Removal of ulcers of necrotic masses and fibrin.
2. Elimination of the sclerosed fibrous margin.
3. Introduction of antibiotics to suppress microflora activity in the periulcerous zone.
4. Injection of drugs that restore the vital functions of tissues.
5. Local administration of drugs that stimulate the regeneration of tissues. Enter from 2-3 points, retreating by 5-6 mm from the edge.
6. Application of substances that protect the surface of the ulcer from the harmful effects of the environment. When the film-forming polymers are applied, the diameter and depth of the mucosal defect are reduced, and thus epithelization is accelerated. The use of film-forming substances promotes the healing of ulcers without the formation of pronounced scars. Ulcers completely epithelialize either leaving no trace, or forming delicate linear or starry scars, almost not protruding above the surface of the mucous membrane.
7. Blockade of nerve endings. Carried out once in 2 days.
8. Blockade of the vaginal trunks during. To 50 ml of novocaine add 2.0 ml of 70-degree alcohol and 2.0 ml of a 0.1% solution of atropine. Enter the area of the cardioesophageal junction from 2 points 1 time in 2 weeks.
9. Stretching of scarring or inflammatory areas of the digestive tract.

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 the endoscopic examination, the decay products are removed mechanically or hydraulically. The overhanging edges are excised by forceps and coagulated. A solution of solcoseryl is injected into the ulcer margin. When granulation occurs instead of solcoseryl, oxyferriccorbone is introduced and oil and glue applications are performed. With "clean" ulcers sclerozirovanny edge is excised, the ulcer cause glue. The pains are eliminated with Novocain blockades. Treatment sessions are performed daily or every other day. In the absence of effect after 10 sessions endoscopic treatment is canceled.

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