Percutaneous endoscopic microgastrostomy as a method of the long-term enteral nutrition therapy and therapeutic treatment of patients

Abstract

Aim. Analysis of the experience of percutaneous endoscopic microgastrostomy use for the long-term enteral nutrition therapy and therapeutic treatment of patients with Parkinson’s disease. 
 Methods. The group of 4-year observation period (2012-2016) included 20 patients aged 55 to 72 with severe form of Parkinson’s disease, mostly males. All patients had microgastrostomy performed in 2008-2012 with the use of «Frezenius» set. Through microgastrostomy levodopa-carbidopa was administered by microdrainage to jejunum. 
 Results. During the first year of functioning of gastrostomy the following complications occured: gastric juice leakage to the skin surface causing the skin maceration (in 2 cases), growth of hypergranulations around gastrostomy (in 3 cases), prolapse of the supporting ring of microgastrostomy to subcutaneous fat causing abscess (in 2 patients). By the end of the fourth year of observation 3 more patients developed prolapse of microgastrostomy to subcutaneous fat without suppuration. The authors in each certain case used different preventive methods and treatment of complications. To prevent gastric juice leakage and growth of hypergranulation, correction of tube fixation and local treatment are necessary; to prevent prolapse of the supporting ring of gastrostomy use of prolene mesh is appropriate. The microgastrostomy should be changed once in 3-4 years with proper care. When microdrainage is used for medication administration through gastrostomy to jejunum, its replacement is necessary at least once in 2 years to prevent bezoar development on catheter. 
 Conclusion. Puncture microgastrostomy performed under endoscopic control can be effectively used for long-term nutrient and medications administration to digestive tract.