Gastroduodenal bleeding in patients with acute cerebrovascular accident

INTRODUCTION. Gastroduodenal bleedings often occurs among patients with cerebrovascular accident (CVA). The frequency, causes and treatment tactics for bleeding from the upper gastrointestinal tract (GIT) in this group of patients have not been sufficiently studied. There were no well established guidelines of treatment for this group of patients, that could be a reason for high mortality. The OBJECTIVE of the study was to improve the treatment outcome of gastroduodenal bleeding cases in patients with cerebrovascular accident (CVA) by using conservative and endoscopic methods that could be used to stop bleeding and developing tactics of treatment in this category of patients. MATERIAL AND METHODS. There were 105 patients with cerebrovascular accident (CVA) and signs of bleeding from the upper gastrointestinal tract in the study. Patients were admitted to the St. Petersburg City Mariinsky Hospital from 2013 to 2018 years. Patients were divided into 2 groups, regarding the type of cerebrovascular accident (CVA): patients with ischemic stroke and patients with hemorrhagic stroke. All patients underwent esophagogastroduodenoscopy (EGD) during 2 hours from identifying the signs of bleeding. RESULTS. In this study, we analyzed medical files and records of patients with diagnosis of ischemic or hemorrhagic stroke, who were admitted to St. Petersburg City Mariinsky Hospital from 2013 to 2018 years. During the observation of patients with diagnosis of ischemic or hemorrhagic stroke, 7483 patients and 1919 patients respectively were treated in the clinic. Among these patients, 58 patients were with diagnosis of acute stroke with ischemic type and 47 patients with acute hemorrhagic stroke in combination with bleeding from upper parts of a GIT. The frequency of the upper GI bleeding was 0.77 % (58 of 7483) in the group with ischemic type of stroke; in the group of patients with hemorrhagic stroke, gastroduodenal bleeding was diagnosed in 2.45 % (47 of 1919) cases. CONCLUSIONS. Endoscopic treatment of gastroduodenal bleeding in cases of ischemic and hemorrhagic stroke was the method of choice. The combined endoscopic hemostasis method was preferred. To achieve hemostasis in cases of superficial lesions of the mucous membrane of the upper gastrointestinal tract and acute ulcers of the gastroduodenal zone in combination with CVA, Argon plasma coagulation (APC) was effective. It was possible to combine APC with other methods of  endoscopic hemostasis that improved the results of treatment and reduced the risk of recurrent bleeding. If bleeding was from chronic ulcers of the stomach and / or duodenum, the method of clipping was effective in combination with APC and / or with injection method. When signs of recurrence of bleeding appeared, all patients with CVA should have undergone esophagogastroduodenoscopy (EGD) and hemostasis by endoscopic methods. All patients with CVA and gastroduodenal hemorrhages combination should have undergone anti-ulcer drug therapy.

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