Evolution of gastrostomy in palliative medicine

Abstract

The article analyzes the world experience in methods of applying of stomach nutritional fistula. Different methods of gastrostomy are described, their classification is given. The advantages and disadvantages of common surgeries are outlined. The most often used traditional surgeries are: gastrostomy by Stamm, Topver and tubular gastrostomy. Complication rate of these operations led to a further search for minimally invasive techniques: percutaneous puncture, laparoscopic gastrostomy, and laparoscopically- assisted percutaneous endoscopic gastrostomy. A significant disadvantage of minimally invasive puncture techniques is the need to purchase relatively expensive disposable sets for primary installation and replaceable low profile tubes. The cost of these supplies in Russia is much higher than the money allocated in the obligate medical insurance system, which makes the method economically unprofitable for medical institutions and patients. Partially, the costs could be reduced by the use, as a gastrostomy tube, a Foley urinary catheter. There are several studies that have confirmed economic advantages and absence of a reliable difference in the number of complications and duration of use such tubes. However, some complications are reported: migration of catheter into the duodenum with the development of obstruction, decreased comfort and quality of life. The conducted study showed absence of classification of gastrostomy types and their complications. The final consensus in clinical use of different types of gastrostomy in different situations is absent. There is a tendency to decrease rate of traditional laparotomical operations in favor of less invasive interventions making it difficult for adequate analyzing. In cases with need for revision, biopsy and fundoplication, laparoscopic or laparoscopically-assisted percutaneous endoscopic gastrostomies are preferred which has proven itself in children. For a group of palliative patients of elderly age with high risk and doubtful prognosis, minimally invasive puncture gastrostomes are more appropriate.

Keywords

gastrostomy / nutritional fistula of the stomach / palliative medicine / laparoscopic gastrostomy / percutaneous endoscopic gastrostomy / complications of gastrostomy / history of gastrostomy / gastrostomy classification

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RIGHTS & PERMISSIONS

Gavshchuk M.V., Gostimsky A.V., Zavyalova A.N., Barsukova I.M., Karpatsky I.V., Lisovsky O.V., Gostimsky I.A.