RU2462207C1 - Method of treating ulcer defects of mucous membrane of gastrointestinal tract - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method relates to surgery and can be applied for treatment of ulcer defects of mucous membrane of gastrointestinal tract. Distal cup intended for performing aspiration method of endoscopic resection of mucosa. Local impact on ulcer defect is performed with low-dose negative pressure in the range 0.15-0.3 atmospheres, for 1-3 minutes, from 1 to 5 times, with 24-72 hour interval between sessions.

EFFECT: method makes it possible to stimulate metabolic and reparative processes.

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Description

The invention relates to surgery, endoscopy, gastroenterology, physiotherapy.

Known methods for treating gastrointestinal ulcerative defects are modern pharmacotherapy (in particular, proton pump inhibitors, eradication therapy, etc., for gastric and duodenal ulcers) and surgical treatment of complicated forms of them (penetration, cicatricial stenosis, perforation, hemostasis ineffectiveness with bleeding, etc.).

Pharmacological agents have a number of disadvantages: they act only on certain pathogenesis factors (in particular, with gastric ulcer and duodenal ulcer), which requires the use of several drugs in combination; their use is often accompanied by side effects (in particular, proton pump inhibitors can adversely affect the blood formation organs, digestive system, central nervous system, skin, cause allergic reactions); they are contraindicated in pediatric patients, during pregnancy, during lactation; they are ineffective in the elderly due to reduced reactivity and degenerative changes in the mucosa [Vasilenko V.Kh. and other peptic ulcer. - M .: Medicine, 1987. - P.286; Derkachev P.V. Endoscopic treatment of chronic gastroduodenal ulcers associated with Helicobacter pylori. Diss. Cand. honey. sciences. - M., 1993]. Surgical treatment of ulcerative defects often leads to disability of the patient. All of the above encourages the search for new ways to treat this pathology.

The closest analogue (prototype) of the proposed method for the treatment of ulcerative defects of the gastrointestinal mucosa is the suction method of endoscopic mucosal resection using a distal cap, first described by H. Inoue et al. [Inoue H., Takeshita K., Hori H., Muraoka Y., Yoneshima H. Endo M. Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions // Gastrointestinal Endoscopy. - 1993, No. 39, p. 58-62]. The essence of the technique is that under visual control a gastroscope with a cap put on its distal end is brought to that part of the stomach that is affected by the tumor. With the help of a vacuum, this section is drawn into the cap and cut off by means of a loop.

The disadvantage of the prototype is the high vacuum practiced with it - from 0.4 to 0.8 atm., Which has a damaging effect on soft tissues and prevents the achievement of a therapeutic effect.

The aim of the invention is to reduce the treatment time for defects in the mucosa of the gastrointestinal tract (gastric and duodenal ulcers and other hollow organs) using the endoscopic method of vacuum therapy using low-dose negative pressure, which stimulates regenerative processes without subjective (on the part of the patient) weighting of endoscopic procedures.

The novelty of the proposed method for the treatment of ulcerative defects of the gastrointestinal mucosa consists in local endoscopic action on the ulcer defect of the gastrointestinal mucosa with a low-dose negative pressure in the range 0.15-0.3 atm. within 1-3 minutes, from 1 to 5 procedures per treatment course with an interval between sessions of 24-72 hours, depending on the dynamics of the regeneration process.

Technical solutions that have features that match the distinguishing features of our proposed method are not identified, which allows us to conclude that the proposed method meets the criterion of "inventive step".

The low-dose negative pressure used in this process has a beneficial, pathogenetically determined effect, including mechanical removal of tissue detritus and fibrin from the bottom of the ulcer defect, reduction of microbial contamination in ulcer tissues, activation of microcirculatory circulation, improvement of lymph circulation with elimination of tissue stagnation, elimination of tissue from toxic substances, elimination of tissue stimulation of metabolic and reparative processes, including due to the formation of small hemorrhages (extravasation ) Without destroying the integrity of capillaries, which in principle autohemotherapy contribute to the immune forces. All of the above contributes to the acceleration of regenerative processes in the zone of ulcerative defects of the gastrointestinal mucosa.

The technical implementation of the proposed method for the treatment of ulcerative defects of the gastrointestinal tract mucosa is provided using known means: a flexible endoscope, a vacuum source (a standard medical suction device with a manometer, a distal cap MB-162 or a distal transparent nozzle (manufacturer "OLYMPUS")).

The proposed method for the treatment of ulcerative defects of the gastrointestinal mucosa is as follows. Before the manipulation, the endoscope is connected to a vacuum source, at the distal end of the endoscope, a distal cap (distal transparent nozzle) is installed. Under anesthesia, a standard endoscopic examination (esophagogastroscopy, colonoscopy, etc.) is performed. If a benign erosive-ulcerative lesion is detected and indications for vacuum therapy are established at the end of the manipulation, the erosive-ulcerative defect is exposed to low-dose negative pressure by creating soft contact between the mucosa and the distal nozzle on the endoscope for 1-3 minutes. The procedure, if necessary, is repeated after 24, 48, 72 hours or during control endoscopic examinations at a later date.

Examples of the use of the proposed method for the treatment of ulcerative defects of the gastrointestinal mucosa

Example 1. Patient F., 63 years old. Diagnosis: peptic ulcer of the stomach and duodenum. An ulcerative history of more than 30 years. Hospitalized urgently for gastric bleeding. Esophagogastroduodenoscopy revealed: a pyloric ulcer 1.0 cm in diameter, 0.4 cm deep with signs of ongoing bleeding (Forrest Ia), duodenal ulcer 1.0 cm in diameter, 0.4 cm deep (Forrest III), cicatricial deformity pyloric bulbar zone with subcompensated stenosis. Performed endoscopic hemostasis by monopolar coagulation. In the future, the patient received infusion, hemostatic therapy, proton pump inhibitors. During the control esophagogastroduodenoscopy, performed 6 days later, it was found that the ulcers were the same size without signs of a threat of recurrence of bleeding (Forrest III). Histological examination of the edges of the pyloric ulcer: chronic atrophic (++) severe (+++) active (+) gastritis with foci of small bowel metaplasia and hyperplasia. Rapid test for Helicobacter pylori (+++). In parallel with standard antiulcer therapy with proton pump inhibitors (without eradication), 3 sessions of endoscopic vacuum therapy were performed (0.2 atm with an exposure of 1 min each and with an interval of 24 hours between them). 24 hours after the first session, detritus disappeared in the ulcer niche. After 3 days, the bottom of the ulcer cleared of fibrin, covered with granulations. After 7 days, due to epithelization and scarring, both ulcers decreased in size up to 0.5 cm in diameter and 0.2 cm deep. Histological examination of pieces of mucous membrane from the edges of the pyloric ulcer: chronic atrophic (++) marked (++) active (+ ) gastritis. With esophagogastroduodenoscopy 14 days after the first session of vacuum therapy, complete ulceration of both ulcers was noted, no visually inflammatory changes in the mucosa were found, patency of the pyloric bulbar region for the apparatus with a diameter of 9.8 mm was restored.

Example 2. Patient K., 48 years old. Diagnosis: gastric ulcer. An ulcerative history since 2006, when endohemostasis was performed for a bleeding stomach ulcer. With planned esophagogastroduodenoscopy, an ulcer was detected on the lesser curvature in the middle third of the body of the stomach with a diameter of 1.0 cm and a depth of 0.4 cm. Histological examination of pieces of mucous membrane from the edges of the ulcer: chronic atrophic (++) expressed (+++) active (++) gastritis. Rapid test for Helicobacter pylori (+). In parallel with standard antiulcer therapy with proton pump inhibitors (without eradication), 3 vacuum therapy sessions were performed (0.3 atm with an exposure of 1 minute each and with an interval between them of 48-72 hours). 48 hours after the first session of endoscopic vacuum therapy, the ulcer cleared of detritus. After 6 days, there was no fibrin in the ulcer niche, the bottom was covered with granulations, marginal epithelization appeared, the ulcer decreased to 0.6 cm, took a slit-like form. On the 14th day, with control esophagogastroduodenoscopy, complete scarring of the ulcer defect was noted.

The proposed method for the treatment of ulcerative defects of the gastrointestinal tract mucosa is used in the treatment of patients with long-existing gastrointestinal ulcers. This method is not accompanied by a significant increase in the duration of endoscopic manipulation, is easily tolerated by patients, and therefore can be used both in inpatient and outpatient settings. In the future, the proposed method of treatment can be used to stimulate reparative processes in the treatment of external and internal fistulas (using fistuloscopy) and local inflammatory and degenerative processes of other internal organs, including diseases of the bronchi, bladder, rectum (anal fissures) and other

Claims (1)

A method for the treatment of ulcerative defects of the gastrointestinal mucosa, which consists in using a distal cap intended for carrying out the suction method for endoscopic resection of the mucosa, characterized in that the local effect on the ulcer defect is carried out by low-dose negative pressure in the range 0.15-0.3 atmospheres, for 1-3 minutes, from 1 to 5 times, with an interval between sessions of 24-72 hours