MIL OSI Translation. Region: Russian Federation –
The new center will improve the quality of cancer care in the city. Malignant tumors will be detected at an early stage.
An endoscopy center, created on the basis of city clinical hospital (GKB) named after S.P. Botkin… The opening ceremony was attended by Sergei Sobyanin.
“Two powerful endoscopy centers are opening in Moscow. One here, in Botkinskaya, and the second will soon open at the Buyanov clinic. And in general, this will allow to provide twice as many opportunities for undergoing gastroscopy and colonoscopy, – said Sergei Sobyanin. “I hope that the number of timely diagnoses and assistance will multiply in Moscow after the introduction of these two centers.”
According to him, research is necessary for the early detection of cancer and diseases of the gastrointestinal tract. Previously, the procedures caused significant discomfort for patients, and many residents were afraid of them.
“Small, low-power centers in Moscow, of course, do not provide the necessary volume of research, and not all of them have the possibilities of general light anesthesia, which would make it possible to comfortably undergo these procedures,” the Moscow Mayor clarified. “Everything here is absolutely painless and comfortable, which is very important.”
Diagnostics and treatment
Endoscopic research methods are used for both diagnosis and treatment of various diseases. Modern endoscopy plays a special role in the early detection of oncological diseases of internal organs.
Most often, endoscopy is combined with biopsy (taking tissue samples for further research), probing and administration of drugs. During the study, it is possible to carry out surgical treatment. This is the removal of small polyps and tumors, stenting of tumor and inflammatory narrowing of the bile and pancreatic ducts, gastrointestinal tract, stopping bleeding, the formation of endoscopic anastomoses between the gastrointestinal tract and cysts.
Now in Moscow, oncological diseases of the digestive system are leading in the structure of the incidence of malignant neoplasms (MNO). According to data for the first half of 2021, tumors of the stomach and intestines account for 23 percent of the total number of diagnosed malignant neoplasms.
In order to increase the level of detection of such diseases in the early stages by expanding access to endoscopic cancer screening, in 2021 the Moscow Government is implementing a pilot project to create specialized centers for gastroscopy and colonoscopy. The first such centers are being created on the basis of two multidisciplinary hospitals – the S.P. Botkin and the V.M. Buyanov (planned to open in the fall of 2021). Their capacity will make it possible to carry out over 950 studies per day (about 340 thousand studies per year).
Chief physician of the hospital named after S.P. Botkina Alexey Shabunin said that this is the first high-flow endoscopy center in Russia and Europe. “The number of patients whom we performed gastrocolonoscopy under general anesthesia has more than doubled. It is very important that this is as comfortable as possible for the patient, it is done under intravenous anesthesia in the shortest time period. And what is even more important – with the highest diagnostic level. During the study, low-traumatic endoscopic interventions are performed immediately, ”he noted.
The equipment of the center allows detecting tumor lesions at the earliest stages thanks to the unique capabilities of microscopy – a magnification of 300-400 times and the function of white and red light.
“By and large, this is the application of elements of artificial intelligence in practical work. With the help of this equipment in the early stages it is possible to identify what was previously impossible, ”added Sergei Sobyanin.
So, in the coming years, the number of endoscopic examinations prescribed to patients of city polyclinics should increase several times. According to forecasts, the number of gastroscopy studies will grow 1.7 times compared with the indicators in the period before the COVID-19 pandemic (in 2019, about 270 thousand studies), and colonoscopy – 3.2 times (in 2019, about 70 thousand studies) … This means that doctors will be able to diagnose more patients more quickly and prescribe treatment in a timely manner in the event of malignant neoplasm.
Within the framework of the pilot project, it is planned to examine, first of all, Muscovites belonging to groups of special risk, including:
– patients with precancerous conditions and diseases;
– family history of relatives of patients with gastric and intestinal cancer;
– patients aged 60–70 years.
If the risk of developing oncological diseases of the gastrointestinal tract is identified, the doctors of the polyclinic, including with the help of telemedicine, will inform the patient about the need for an examination, organize preparation for this procedure (help to do the necessary tests) and send them to the endoscopy center. In addition, the call center staff will remind you to make an appointment with a doctor, inform you about the necessary tests and the rules for preparing for an endoscopic examination.
“An extremely important step, from my point of view, because the analysis of the oncological situation in the city shows: in fact, every fourth newly diagnosed patient is a patient with neoplasms of the gastrointestinal tract. The key to success and effective care is early diagnosis. Of course, such high-flow centers that meet two very important criteria – the effectiveness and safety and comfort of invasive examinations – are probably the only way to improve the results of both diagnostics and early treatment, when it is possible to resort not only to abdominal surgeries, but also to endoscopically solve at the very initial stages and stop the disease, ”said Denis Protsenko, chief physician of the city clinical hospital No. 40 in Kommunarka.
Specialists of the new endoscopy centers will carry out diagnostic procedures and, if possible, remove neoplasms right on the spot or send them for surgical treatment. Biomaterial taken from patients, if necessary, will be delivered to one of the six city specialized pathomorphological laboratories for histological, molecular genetic and immunohistochemical studies.
The studies will be carried out under intravenous sedation, which minimizes the patient’s discomfort, creates a comfortable working environment for the doctor, and reduces the time required for examination and intervention.
Timely diagnostics, available at the center, will make it possible to detect cancer in the early stages (cancer of the stomach and colon), start treatment in a timely manner (low-traumatic surgical interventions) and, in some cases, after radical endoscopic removal of the tumor, refuse extensive cavity operations, chemotherapy and radiation therapy.
If cancer is confirmed, the patient will be monitored by an oncologist and assigned for observation and further treatment at the place of residence in one of the outpatient oncological care centers created on the basis of the six largest city hospitals (GKB named after S.P. Botkin, GKB No. 57 named after D. D. Pletnev, Moscow Clinical Research Center named after AS Loginov, Moscow City Oncological Hospital No. 62, City Clinical Hospital No. 40, City Clinical Oncological Hospital No. 1).
If, according to the results of laboratory tests (in the case of removal of a polyp or neoplasm), no oncological diseases are detected or inflammatory diseases are found, then the patient will be under dispensary observation by a therapist or gastroenterologist. In cases where no pathologies are identified, a follow-up examination in five years will be recommended.
Endoscopy Center of Botkin Hospital
Endoscopy Center of S.P. Botkin occupies the first two floors of building number 22, a comprehensive renovation of which was completed in July 2021. Previously, it housed the hospital’s non-medical services – an information technology center, a paid services department and a functional diagnostics department, which were transferred to other premises of the same building.
The total area of the center is 1.2 thousand square meters. It will conduct over 320 studies per day (about 115 thousand studies per year). In 2020, 15 thousand outpatient endoscopic examinations were performed at the Botkin Hospital.
On the ground floor there is a reception, where they give out a bracelet with a QR code containing information about the patient and the study being carried out, as well as a comfortable waiting area, a cloakroom and a doctor’s office.
On the second floor there is a reception area, changing rooms and a waiting area, eight endoscopic treatment rooms with a wake-up room for 10 beds, consultative and diagnostic rooms, a resident’s office and a washing room.
In the endoscopy center of the Botkin Hospital, about 200 units of modern medical equipment have been installed, including 10 endoscopic racks, 19 video colonoscopes, 30 video gastroscopes and three video bronchoscopes were purchased under life cycle contracts. In particular, the Fujifilm Eluxeo apparatus will help supplement the standard endoscopic examination with tumor tissue microscopy (magnification 400 times), and will provide storage and transmission of video information.
Convenient logistics will allow you to conduct an examination in a comfortable environment and in the shortest possible time – in just 1.5 hours, including rest after the procedure. In the future, this can be done on any day of the week and at any time of the day.
The center has created a barrier-free environment for people with limited mobility – there are ramps and handrails.
Information about the patients of the endoscopy center will be uploaded to a single digital platform in the city of Moscow – the research results will be available to both the patient and the doctor of the polyclinic in an electronic medical record.
At the moment, the center employs 26 people, including 13 doctors, 11 nurses and two other staff. As the flow of patients grows, the state is planned to expand.
Modernization of the Botkin Hospital
Now the implementation of the program for the integrated development of the Botkin Hospital continues.
By the end of 2021, it is planned to complete the repair of five hospital buildings.
Building No. 7 – surgical
It was built in 1970, its area is 6.2 thousand square meters. After overhaul and complete re-equipment, the department of purulent traumatology for 30 beds with two specialized operating rooms and an intensive care unit for six beds will move to the building.
It is a unique multidisciplinary unit that combines purulent surgery, traumatology, orthopedics and reconstructive plastic surgery. The priority area of activity is providing assistance to patients with traumatological and orthopedic pathology of the musculoskeletal system, complicated by infection. The opening of the department in building No. 7 will increase the number of treated patients from 2025 to five thousand per year and the number of operated patients from 1355 to 4200.
Also, a short-term hospital for 12 beds with three operating rooms will be organized in the building. Patients will be able to undergo a full cycle of preoperative and inpatient diagnostics and treatment with follow-up follow-up. This will increase the number of surgical interventions by two and a half times – up to 10 thousand operations using video endoscopic technology (in 90 percent of cases). An increase in the flow of patients in the hospital will make it possible to free up round-the-clock beds for more severe patients.
Building number 28 – oncological
Built in 1951, its area is 3.7 thousand square meters. Previously, there was a medical school in the building. After the overhaul and complete re-equipment, it is planned to place an outpatient oncological care center there.
The creation of the center will allow organizing a full cycle of diagnostics and treatment of specialized patients at the Botkin Hospital (diagnosis – surgical treatment – drug or chemotherapy – rehabilitation – observation). More than 200 thousand consultations will be given here per year. The presence of 22 beds in the day hospital will allow up to 25 thousand courses of chemotherapy annually.
Building No. 6 – palliative
This building with an area of 0.98 thousand square meters was built in 1911. The building is an architectural monument. After the completion of the renovation, a palliative department will be located there. Here, patients will be able to receive the necessary medical care in the most comfortable conditions, surrounded by doctors and specially trained nurses.
Building number 8 – catering
The two-storey building with a basement was built in 1909. It has not been used since 2006. Previously, a catering unit was located here. After restoration and major overhaul, it is also planned to place a catering unit with a tableted food line, modern refrigerating machines and equipment for preparing food for 1800 patients six times a day in the building.
Building number 11 – interdistrict nephrological center
The three-storey building with an area of 6.5 thousand square meters was built in 1911 and is an architectural monument. After repairs, an interdistrict nephrological center with 60 beds was deployed in the building. It will have a nephrology department, a hemodialysis and peritoneal dialysis laboratory, and a day hospital (nephrology). Now these units are scattered across different buildings of the hospital. Their combination will increase the number of hemodialysis procedures by 20 percent, and the number of those treated with peritoneal dialysis – by 25 percent. The comfort of the patients’ stay will be significantly increased. The area of dialysis rooms will increase.
The center will undergo dynamic observation and treatment of outpatients with chronic kidney disease (CKD) – residents of three administrative districts of Moscow (Central Administrative District, CAO and SZAO). This is expected to improve the quality of outpatient care and help delay the onset of the dialysis phase of CKD in at least 200 people annually.
The next stage of the comprehensive development program for the Botkin Hospital will be a major overhaul of five more buildings. The work is planned to be carried out from 2022 to 2023.
Building number 8 – therapeutic
Built in 1911, it is an architectural monument. Its area is two thousand square meters. After major repairs and re-equipment, it is planned to open a therapeutic department here.
Building number 10 – medical and scientific-academic
Built in 1911 and is an architectural monument. The building area is 6.9 thousand square meters.
Today, the building houses the departments of nephrology and anesthesiology-resuscitation, which will continue to work after major repairs. Also, 24 departments of leading medical research centers and universities, which are now located in different buildings of the hospital, will be transferred here. It will equip transformable lecture halls and auditoriums with modern media systems. With their help, specialists and students of medical universities will be able to watch online broadcasts from the operating rooms of the Botkin Hospital.
Building number 9 – surgical
Built in 1911, it is an architectural monument. The area of the building is 2.9 thousand square meters.
After renovation, a 10-bed endoscopic intraluminal surgery hospital will be opened here, as well as a short-term surgery and gynecological hospital with 30 beds.
Building No. 2 – medical
Built in 1912, it is an architectural monument. The building area is 3.3 thousand square meters.
After a major overhaul and re-equipment, the building will accommodate a 30-bed therapeutic and pulmonology department, as well as a 15-bed radiology department.
Building number 20 – Moscow City Urological Center
The building was built in 1966. Its area is 8.8 thousand square meters.
Now there are departments of hemodialysis, palliative medicine, cardiology for patients with acute myocardial infarction and others.
After the renovation, the Moscow Urological Center for 160 beds with six operating rooms will be opened in building 20. They will house four robotic surgical complexes, as well as 12 intensive care beds, an outpatient clinic for patients with urological diseases with a wide diagnostic base (MRI, CT, X-ray room).
New ambulance building
Another major project in the coming years is the construction of a modern inpatient building (admission department) of an ambulance on the territory of the city clinical hospital named after S.P. Botkin.
Instead of the traditional principle “patient – to the doctor”, the work of the new admission department is organized according to the principle “doctor – to the patient”. It is not the patients who will go to the offices, but the specialists will come to them. To do this, the admission department will open:
– diagnostic department for 30 beds;
– intensive care unit for 13 beds;
– anti-shock ward for 10 beds;
– rooms for CT, MRI, ultrasound, endoscopy, X-ray, angiography;
– an operating unit for eight tables.
Upon admission to the ward, the patient will be met by a doctor at the distribution post, who will determine the routing and sequence of care. Then, accompanied by a medical registrar, the patient will be sent to one of the examination rooms. The medical registrar will enter his data into the information system. A doctor of the required specialty, having received a notification, will go to the bed, examine the patient and prescribe the necessary examinations.
Doctors will work as part of a multidisciplinary team, which is especially important for patients with lesions of various organs and systems.
The procedures, diagnostic examinations and consultations, which can be performed in a mobile mode, will be carried out directly at the patient’s bed. If it is necessary to conduct inpatient examinations, the patient will be transported accompanied by medical staff. Modern equipment in the operating and intensive care unit will reduce the risk of postoperative complications.
Thus, during his stay in the emergency department, the patient will be constantly under the supervision of the medical staff. Also, he will not need to move independently.
In the new building, emergency patients will receive the full range of medical care (diagnostics, surgery, resuscitation measures) within the first 24 hours after hospitalization. Then, depending on their condition, they will either be discharged home or transferred to the specialized department of the hospital.
All types of treatment
City Clinical Hospital named after S.P. Botkina is one of the most equipped in Moscow. In recent years, specialists have managed to completely re-equip the diagnostic and treatment facilities of the institution. Thus, more than 13 thousand units of modern medical equipment were purchased for over six billion rubles.
Today, the clinic’s diagnostic service has a full range of modern medical equipment of an expert class: it has 91 ultrasound machines, six computed tomographs and three magnetic resonance tomographs, 12 video endoscopic stands, four X-ray endovascular complexes and a Da Vinci surgical robot. All this provides the entire volume of laboratory and instrumental examination of patients.
Every year in the Botkin hospital, more than 100 thousand people receive inpatient care and more than 60 thousand operations are performed. All types of treatment are available in 90 departments.
On the basis of the hospital, there are 10 city medical specialized centers. Among them, the Regional Vascular Center, the Moscow City Hematology Center, the Center for Bone and Joint Endoprosthetics, the Center for the Diagnosis and Treatment of Toxoplasmosis, the Center for Organ Donation, the Center for the Diagnosis and Treatment of Extrapyramidal Diseases, the Intercircular Nephrology Center, the Moscow City Ophthalmology Center, the Simulation Training Center for Medical Workers and the Center outpatient cancer care.
The hospital is a clinical base for 24 departments of six leading medical research centers and universities in Russia.
Fighting the pandemic
During the peak of the pandemic, the city clinical hospital named after S.P. Botkina was one of the hospitals that continued to provide emergency and planned care to patients, primarily oncological, nephrological and hematological profiles. A huge burden fell on the doctors of the medical institution, which they successfully coped with. Since March 2020, they have cured 200 thousand patients and performed 75 thousand operations.
In the spring of last year, a temporary coronavirus hospital with 125 beds was deployed in building No. 21, where over 890 patients were treated and 76 emergency operations were performed. In July 2020, it was closed and re-profiled into a medical building.
Since September 28, 2020, a reserve building has been put into operation on the territory of the hospital, in which testing for COVID-19 is carried out in planned patients, including patients of the hematology and ophthalmology departments. For all the time of his work, biomaterial for research was taken from more than 41 thousand people. Thanks to the transfer of some of the diagnostic procedures to the reserve building, the consultative and diagnostic center in building No. 22, the day hospital in the Moscow City Hematological Center (building No. 17) and the outpatient department of the Moscow City Ophthalmological Center were unloaded.
EDITOR’S NOTE: This article is a translation. Apologies should the grammar and or sentence structure not be perfect.