SUCCESSFUL EXPERIENCE OF IMPORT SUBSTITUTION OF PUNCTURE TECHNOLOGIES FOR THE ENTERAL FEEDING OF PALLIATIVE PATIENTS
Abstract
Introduction. To organize enteral nutrition for palliative patients, preference is given to percutaneous methods of forming a gastrostomy, which may be unavailable due to import restrictions
on the necessary consumables. As part of the conducted research, an original minimally invasive technology for creating a feeding fistula has been developed. The aim of the study is to present
accumulated experience of the successful use of enteral access for feeding palliative patients through minimal gastrostomy via minilaparotomy. Materials and methods. The study was conducted at the clinical base of the Saint Petersburg State Pediatric Medical University in City Hospital No. 26. Patient selection criteria included dysphagia grades III–IV, inability to radically eliminate the cause of dysphagia and perform a puncture gastrostomy, and informed voluntary patient consent. The results and discussion. Minimal gastrostomy via minilaparotomy was performed in 24 patients aged from 37 to 85 years, with an average age of 60.6 ± 13.87 years. The procedure was performed under general anesthesia in 22 (91.7 %) cases and under local anesthesia in 2 (8.3 %) cases. The duration of the intervention ranged from 25 to 65 minutes, with an average of 31.3 ± 8.24 minutes. There were no major complications related to gastrostomy. Minor complications were observed in 5 (20.8 %) cases in the early postoperative period. Nineteen (79.2 %) patients were discharged for outpatient care or transferred to hospice care, while 5 (20.8 %) patients died during the hospitalization period due to causes unrelated to the surgery. After discharge, 18 (75 %) patients were under observation. At the time of writing this article, 14 (58.3 %) patients died within a range of 4 to 69 days, with an average of 27.1 ± 19.18 days. Another 4 patients continued to be monitored for periods of 38, 79, 94, and 310 days. Conclusion. The presented five-year experience of using minimal gastrostomy via minilaparotomy allows us to consider this procedure as a potential means of import substitution when percutaneous gastrostomy methods are not feasible.
References
Белевич В.Л., Струков Е.Ю., Бреднев А.О., Овчинников Д.В. Чрескожная эндоскопическая гастростомия — метод выбора для длительного энтерального питания. Новости хирургии. 2014; 22(6): 750–4.
Гавщук М.В., Лисовский О.В., Гостимский А.В. и др. Подготовительный этап к импортозамещению в паллиативной педиатрии на примере гастростомии. Children’s medicine of the North-West. 2021; 9(1): 84–5.
Гавщук М.В., Лисовский О.В., Гостимский А.В. и др. Хирургические методы коррекции дисфагии у взрослых паллиативных больных по данным системы ОМС. Медицина и организация здравоохранения. 2021; 2(6): 21–6.
Гавщук М.В., Лисовский О.В., Гостимский А.В. и др. Клинические наблюдения минимальной гастростомии через минилапаротомию у паллиативных больных. Acta Biomedica Scientifica (East Siberian Biomedical Journal). 2022; 7(1): 182–8. DOI: 10.29413/ABS.2022-7.1.21.
Гостимский А.В., Гавщук М.В., Завьялова А.Н. и др. Особенности нутритивной поддержки и ухода за пациентами с гастростомой. Медицина: теория и практика. 2018; 3(2): 3–10.
Гурциев М.Х., Ярцев П.А., Тетерин Ю.С. Лапароскопически-ассистированное устранение послеоперационного осложения чрескожной эндоскопической гастростомии. Журнал им. Н.В. Склифосовского Неотложная медицинская помощь. 2021; 10(4): 808–12. DOI: 10.23934/2223-9022-2021-10-4-808-812.
Завьялова А.Н., Гостимский А.В., Лисовский О.В. и др. Энтеральное питание в паллиативной медицине у детей. Педиатр. 2017; 6(8): 105–13. DOI: 10.17816/PED86105-113.
Завьялова А.Н., Новикова В.П., Орел В.И. и др. Организация питания стомированного пациента. Выбор пищевого субстрата. Педиатр. 2023; 14(2): 93–104. DOI: 10.17816/PED14293-104.
Красильников И.А., Орел В.И., Кузнецова Е.Ю. и др. Общественное здоровье и здравоохранение. СПб.: Петрополис; 2000.
Петровский А.Н., Попов А.Ю., Барышев А.Г. Чрескожная эндоскопически-ассистированная гастростомия. Хирургия. Журнал им. Н.И. Пирогова. 2019; 8: 69–73.
Gkolfakis P., Arvanitakis M., Despott E.J. et al. Endoscopic management of enteral tubes in adult patients — Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021; 53(2): 178–95. DOI: 10.1055/a-1331-8080.
Nunes G., Fonseca J., Barata A.T. et al. Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique? GE Port J Gastroenterol. 2020; 27(3): 172–84. DOI: 10.1159/000502981.
