Analysis of artificial nutrient fistula application cases according to the information system of the city multidisciplinary hospital

Introduction. There is no separate register of patients with dysphagia who need an artificial nutritional fistula and enteral nutrition. The situation can be indirectly judged by the data of the information system of the city multidisciplinary hospital in which these operations are performed.

The purpose and objectives of the study. To study the structure of nosology, the order of hospitalization of patients with dysphagia and the ways of applying nutritional fistulas in the city multidisciplinary hospital of St. Petersburg.

Material and methods. The data of the St. Petersburg municipal hospital № 26 information system of cases of gastrostomy and eunostomy in 2021 are analyzed.

Results and discussion. In 2021, artificial nutritional fistulas were applied to 62 patients aged from 20 to 83 years, 63.1±12.64 years in average. In 49 (79.0%) hospitalized patients, the cause of dysphagia was malignant tumors that had already been diagnosed earlier. In 10 (16.1%) cases, patients underwent percutaneous endoscopic gastrostomy using the pull method, while dysphagia was of a functional nature and was a complication of non-tumor diseases. The patients operated by this method were aged from 20 to 80 years, 53.4±20.08 years in average. The imposition of an artificial nutrient fistula through laparotomy was performed in 52 (83.9%) patients aged 43 to 83 years, 64.94±9.90 years in average. All the patients of this group were older than patients, received puncture gastrostomy under the control of an endoscope (p<0.05).

Conclusion. It is necessary to determine the tactics of monitoring of patient with dysphagia and resolving the issue of timely hospitalization for gastrostomy. Planned hospitalization for palliative intervention before the appearance of signs of decompensation of the general condition and obstruction of the upper digestive tract, will allow performing minimally invasive and, as a consequence, low-traumatic puncture methods of gastrostomy.

1. Belkin A.A., Ershov V.I., Ivanova G.E. Impairment of swallowing in urgent conditions-postextubation dysphagia. Russian Journal of Anaesthesiology and Reanimatology, 2018, No. 4, pp. 76–82 (In Russ.).

2. Komarov A. N., Vasilieva A.S. Long-term care system with metabolic monitoring «care at home» for patients with dysphagia. Pallium: palliative and hospice care, 2020, No. 4, pp. 34–44 (In Russ.).

3. Dziewas R., Allescher H.D., Aroyo I. et al. Diagnosis and treatment of neurogenic dysphagia — S1 guideline of the German Society of Neurology // Neurol. Res. Pract. 2021. Vol. 3, 23. Available at: https://www.ncbi.nlm. nih.gov/pmc/articles/PMC8094546/pdf/42466_2021_Article_122.pdf (accessed: 08.07.2022).

4. Kukosh M.Yu., Ter-Ovanesov M.D. Home enteral nutrition: international experience. Medicinskij alfavit, 2018, No. 29 (366), pp. 38–42 (In Russ.).

5. Ostapenko V.S., Balaeva M.M., Runikhina N. K., Krylov K. Yu. Malnutrition in hospitalized older patients. Clinical case. Russian Journal of Geriatric Medicine, 2021, No. 1, pp. 110– 115 (In Russ.).

6. Kucher M. A., Rotan N.G. Features of feeding and nutrition support in palliative care. Palliative Medicine and Rehabilitation, 2021, No. 2, pp. 25–30 (In Russ.).

7. Gavschuk M.V., Gostimskii A.V., Bagaturiya G.O. et al. Import Substitution Possibilities in Palliative Medicine. Pediatrician (St. Petersburg), 2018, No. 9 (1), pp. 72–76 (In Russ.)

8. Arvanitakis M., Gkolfakis P., Despott E.J. et al. Endoscopic management of enteral tubes in adult patients — Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline // Endoscopy. 2021. No. 53 (1). Р. 81–92.

9. Order of the Government of St. Petersburg On approval of the program of St. Petersburg «Development of the palliative care system» for 2019–2024 dated August 28, 2019 No. 31-rp (In Russ.).

10. Gavshchuk M. V., Lisovskii O. V., Gostimskii A. V. et al. Clinical observations of minimal gastrostomy through minilaparotomy in palliative patients. Acta biomedica scientific, 2022, No. 7 (1), pp. 182–188 (In Russ.).

11. Gavshchuk M. V., Lisovskii O. V., Gostimskii A. V. et al. Surgical methods of dysphagia correction in adult palliative patients according to the data of the compulsory health insurance system. Medicine and health care organization, 2021, No. 6 (2), pp. 21–26 (In Russ.).