sibmedСибирский научный медицинский журналСибирский научный медицинский журнал2410-25122410-2520ИЦиГ СО РАН10.18699/SSMJ20210601sibmed-693Research ArticleОБЗОРЫREVIEWSСовременные подходы к эндоскопическому лечению пациентов с острыми неварикозными кровотечениями из верхних отделов желудочно-кишечного трактаModern management of acute non-variceal upper gastrointestinal bleedinghttps://orcid.org/0000-0002-1121-9636ДарвинВ. В.DarvinV. V.

Владимир Васильевич Дарвин, д.м.н., проф. 

628400, г. Сургут, ул. Ленина, 1

Vladimir V. Darvin, doctor of medical sciences, professor 

628400, Surgut, Lenin str., 1

dvv@mf.surgu.ruhttps://orcid.org/0000-0003-2293-136XИльканичА. Я.IlkanichA. Ya.

Андрей Яношевич Ильканич, д.м.н.

628400, г. Сургут, ул. Ленина, 1

Andrey Ya. Ilkanich, doctor of medical sciences 

628400, Surgut, Lenin str., 1

ailkanich@yandex.ruhttps://orcid.org/0000-0003-2192-8396РыжиковМ. Г.RyzhikovM. G.

Михаил Григорьевич Рыжиков

628606, г. Нижневартовск, ул. Ленина, 18

Mikhail G. Ryzhikov 

628606, Nizhnevartovsk, Lenin str., 18

orcchief@yandex.ruhttps://orcid.org/0000-0003-0917-9994ОганянА. В.OganianA. V.

Армен Валерьевич Оганян

628606, г. Нижневартовск, ул. Ленина, 18

Armen V. Oganian 

628606, Nizhnevartovsk, Lenin str., 18

niak1994@mail.ruСатиновА. В.SatinovA. V.

Алексей Владимирович Сатинов

628606, г. Нижневартовск, ул. Ленина, 18

Alexey V. Satinov 

628606, Nizhnevartovsk, Lenin str., 18

adm@okbnv.ruСургутский государственный университетРоссияSurgut State UniversityRussian FederationНижневартовская окружная клиническая больницаРоссияNizhnevartovsk Regional Clinical HospitalRussian Federation202125122021416417Copyright © Дарвин В.В., Ильканич А.Я., Рыжиков М.Г., Оганян А.В., Сатинов А.В., 20212021Дарвин В.В., Ильканич А.Я., Рыжиков М.Г., Оганян А.В., Сатинов А.В.Darvin V.V., Ilkanich A.Y., Ryzhikov M.G., Oganian A.V., Satinov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://sibmed.elpub.ru/jour/article/view/693

Острые кровотечения неварикозного характера из верхних отделов желудочно-кишечного тракта остаются актуальной клинической проблемой. Эпизоды кровотечения ассоциируются с высокой смертностью и значительной экономической нагрузкой на систему здравоохранения. Несмотря на продолжающееся улучшение методов эндоскопического гемостаза, рецидивы кровотечений и связанная с ними смертность остаются на достаточно высоком уровне. Помимо устоявшихся методов эндоскопического гемостаза (инъекционного, термического, механического), используемых как одиночно, так и в составе комбинированной терапии, в обзоре рассматриваются вопросы о применении новых видов эндоскопических устройств. Описаны результаты применения клипс over-the-scope, щипцов для горячей биопсии, методов топического гемостаза, эндоскопической ангиографии, радиочастотной абляции, криотерапии и эндоскопического сшивающего устройства. Рассмотрены технические аспекты их применения, вопросы эффективности и безопасности, преимущества и ограничения методов для достижения окончательного эндоскопического гемостаза. Проанализированы методы предварительной оценки и стратегии лечения при рецидивных кровотечениях и неудачном эндоскопическом гемостазе. Материал и методы. Поиск литературы проводился с использованием следующих электронных информационных ресурсов: CyberLeninka, PubMed, Nature Pathology, MEDLINE, PLoS ONE. Результаты. Комбинированный эндоскопический гемостаз является стандартным методом лечения пациентов с острыми неварикозными кровотечениями из верхних отделов желудочно-кишечного тракта, его эффективность составляет 95–98 %. Новые методы эндоскопического гемостаза способны обеспечить окончательный эндоскопический гемостаз как при первичном эндоскопическом лечении, так и при рецидиве кровотечения.

Acute, non-varicose bleeding from the upper gastrointestinal tract remains a common clinical problem. Bleeding episodes are associated with high mortality and a significant economic burden on the health care system. Despite the continuing improvement in endoscopic treatment, recurrent bleeding and associated mortality are still a pressing issue. In addition to the well-established modalities of endoscopic hemostasis: injection, thermal, mechanical, used both as mono therapy and as part of a combination therapy, the review discusses the use of novel types of endoscopic devices. The results of the use of over-the-scope clips, coagrasper, hemostatic sprays, endoscopic angiography, radiofrequency ablation, cryotherapy and endoscopic suturing device are described. The technical aspects of their application, the issues of efficacy and safety, the advantages and limitations of methods for achieving final endoscopic hemostasis are considered. The methods of initial assessment and treatment strategies for recurrent bleeding and unsuccessful endoscopic hemostasis were also analyzed. Material and methods. Literature search was carried out using the following electronic information resources: CyberLeninka, PubMed, Nature Pathology, MEDLINE, PLoS ONE. Results. Сombined endoscopic hemostasis is a standard therapy in the treatment of gastrointestinal tract cerebral infections with an efficiency of 95-98 %, new modalities of endoscopic hemostasis are able, in some cases, to achieve final endoscopic hemostasis both in primary endoscopic treatment and in recurrent bleeding.

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The authors declare that there are no conflicts of interest present.