ЕXPERIENCE OF LONG-TERM APPLICATION OF PERCUTANEOUS ENDOSCOPIC MICROGASTROSTOMY AS A METHOD OF ENTERIAL AND THERAPEUTIC PROVISION OF PATIENTS

Abstract

Purpose. Analysis of surgical aspects of the experience of 13 years of percutaneous endoscopic microgastrostomy for enteral therapeutic provision of patients with parkinsonism.

Methods. The 4-year follow-up group (2012-2021) included 20 patients aged 55 to 72 years with severe Parkinson's disease, mostly men. From 2008 to 2012, patients underwent microgastrostomy installation using a Frezenius kit. Levodopa carbidopa was injected into the jejunum through a micro-drainage gastrostomy.

Results. During the 1st year of gastrostomy functioning, the following complications developed: gastric juice leakage onto the skin with the skin maceration development (2 cases), the hypergranulation development around the gastrostomy (3 cases), the gastrostomy support ring prolapse into subcutaneous fat with an abscess development (2 patients). By the end of the 4th year follow-up, 3 more patients had gastrostomy prolapse into subcutaneous tissue without suppuration. On the micro-drainage part complications were observed in the form of the bezoar formation at the tube end and micro-drainage nodulation in the stomach with the lumen obturation. The author used different methods of prevention and complications treatment in each individual case. To prevent gastric juice leakage and the proliferation of hypergranulations, tube fixation correction and local treatment are necessary; to prevent prolapse of the gastrostomy support ring, it is advisable to use a prolene mesh gasket. A gastrostomy change l with proper care is advisable 1 time in 3-4 years, micro-drainage at least 1 time in 2 years to prevent the bezoar formation on the catheter and its rupture.

Conclusion. Puncture microgastrostomy performed under endoscopic control can be effectively used for a long time to inject nutritional mixtures and medicines into the gastrointestinal tract.