The Effectiveness of Medical Preparation for Endoscopy of Obese Patients with Active Gastrointestinal Ulcer Bleeding
Authors: Reiti Andrian , Sherbyna Oleksandr 
Published: November 2024

Since the beginning of the 90s of the XX century the endoscopic methods in medicine are the “gold standard” both for the diagnosis of stomach ulcers and for the treatment of such complications as gastrointestinal bleeding. Despite the development of technologies and opportunities, the question of effective emergency preparation of the digestive tract for examination is still acute, because the quality of preparation directly affects the outcome of treatment.
Today, routine cleansing of the stomach by nasogastric lavage is mainly used, as it was 70 years ago. The method is quite controversial due to the risks of decompensation of concomitant diseases, the rapid development of hypercapnia and oxygen desaturation, the risk of aspiration pneumonia, which put the practitioner in a difficult situation, especially when it comes to obese patients. That is why, in most cases, doctors use waiting approach. The use of parenteral prokinetic agents for such patients is a promising alternative. The study analyzed the effectiveness of medicated versus “traditional” preparation of nasogastric lavage.
The objective: to evaluate the effectiveness and determine the expediency of using drug preparation of the stomach for emergency gastroscopy in patients with active gastrointestinal ulcer bleeding on the background of obesity; to conduct a comparison of the effectiveness of medication and “traditional” mechanical preparation; to analyze the presence of a relationship between the effectiveness of preparation and early recurrences of bleeding.
Materials and methods. The results of endoscopic diagnosis and treatment of gastrointestinal ulcer bleeding in 100 obese patients (BMI > 30 kg/m2), evenly distributed by gender and age, were analyzed and compared. The main group included 50 patients who were medically prepared for the examination by intravenous infusion of 2 ml of metoclopramide hydrochloride and 10 ml of a 10% hypertonic solution of sodium chloride, 15 minutes before the procedure. The control group also included 50 patients who were prepared for the examination by mechanical cleaning by gastric lavage with cold water (4C) through a 16F nasogastric tube.
During the study, the quality of visualization according to the Frossard scale, the effectiveness of hemostasis, and the frequency of early recurrence of bleeding were evaluated. Statistical analysis was performed using Fisher’s exact test and t-test.
Results. In the patients of the main group who were treated with medication, the average duration of the endoscopic examination was 15±32.3 minutes. In patients of the control group, who had mechanical gastric lavage by washing with cold water, the duration of the examination was twice longer – 31±25.5 minutes. Better visualization (78% vs. 50%, respectively; p=0.0064) was found in the main group. Effective hemostasis was more often achieved in the experimental group as well (90% vs. 68%; p=0.0128). There were no significant differences in the need for repeat endoscopy (16% vs. 28%; p=0.2270) or early recurrent bleeding (12% vs. 16%; p=0.7742) during the study.
Conclusions. Medication preparation for emergency gastroscopy provides better visualization and reduces procedure time compared to standard preparation by gastric lavage through a nasogastric tube. Better visualization is directly related to effective hemostasis. However, good visualization does not reduce the frequency of repeat endoscopies or early recurrence of bleeding.