Percutaneous endoscopic gastrostomy in patients with neurodegenerative diseases

Abstract

Introduction. In recent years, there has been a clear trend in the use of high-tech treatment methods known in medicine in the provision of palliative care to improve the quality of life of patients with amyotrophic lateral sclerosis and spinal muscular atrophy.Target. To evaluate the effectiveness of minimally invasive treatment technologies used in the City Geriatric Medical and Social Centre (St. Petersburg, Russia) to restore full enteral nutrition in incurable patients in the provision of palliative care.Materials and methods. An observational retrospective cohort study based on archival case histories of patients with amyotrophic lateral sclerosis and spinal muscular atrophy admitted to the Respiratory Support Centre at the City Geriatric Medical and Social Centre (St. Petersburg, Russia) was conducted in 2018–2021.Results and discussion. The most commonly used method of restoring natural enteral nutrition in patients with amyotrophic lateral sclerosis and spinal muscular atrophy was percutaneous endoscopic gastrostomy performed according to the PULL (pullthrough) method according to Gauderer–Ponsky (pulling on itself), and in patients with severe malnutrition, percutaneous endoscopic gastrostomy according to PUSH technique using introducers. Also in demand was the endoscopic replacement of the gastrostomy tube with a gastrostomy bolus tube. Performing percutaneous endoscopic gastrostomy in difficult clinical conditions (patient position, oropharyngeal paresis, stiffness and contractures in the cervical and upper thoracic spine, impaired mental status) required highly qualified personnel capable of providing full-fledged surgical, anesthesiology and endoscopic care. The nature of postoperative complications made it possible in all cases to achieve their elimination in the early postoperative periods without lethal outcomes.Conclusions. The evolution of methods and methods of providing palliative care corresponds to the general trend in the development of medicine and strives for high-tech, highly informative methods of treatment. With the use of modern methods of specialized treatment, the number of failures in clinical practice is reduced and the professional competence of specialists in the palliative care department is increased. Percutaneous endoscopic gastrostomy in patients with amyotrophic lateral sclerosis and spinal muscular atrophy, diagnosis of possible early or late complications require the participation of a qualified surgeon, endoscopist and anesthesiologist, as well as the use of the entire range of diagnostic methods possible in a multidisciplinary hospital. The transition to high-tech methods of providing palliative care using modern instrumental techniques requires both legislative and timely budgetary support.