Современные подходы к эндоскопическому лечению пациентов с острыми неварикозными кровотечениями из верхних отделов желудочно-кишечного тракта

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.

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