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. 2022 Jan 13;22(1):25.
doi: 10.1186/s12883-021-02546-5.

PEG-J replacement for duodenal levodopa infusion in Parkinson's disease patients: a retrospective study

Simone Simoni  1   2 , Pasquale Nigro  1 , Marta Filidei  2 , Giulia Cappelletti  2 , Federico Paolini Paoletti  2 , Danilo Castellani  3 , Mirko Gaggiotti  3 , Lucilla Parnetti  2 , Nicola Tambasco  4   5
Affiliations

PEG-J replacement for duodenal levodopa infusion in Parkinson's disease patients: a retrospective study

Simone Simoni et al. BMC Neurol. .

Abstract

Background: Reducing percutaneous endoscopic gastrostomies with jejunal extension tubes (PEG-J) related complications is vital to the long-term preservation of duodenal levodopa infusion (DLI) in advanced Parkinson's disease (APD). Here, we provide data on the frequency of complications for both the standard "pull" and the non-endoscopic, radiologic assisted, "push" replacement PEG-J techniques in APD.

Methods: We retrospectively identified all patients treated with DLI from October 2009 to January 2020 at the Movement Disorders Center. Patients features and demographics, PEG-J procedures, causes for any discontinuation, reported complications and mortality were collected. In this cohort, PEG-J replacements were performed using the standard "pull" procedure or the radiologic assisted "push" method. Descriptive statistical analysis, t-test and paired t-test with False Discovery Rate correction was performed.

Results: This retrospective study included 30 APD patients [median age 72 ± 5.6 years; mean disease duration 17.2 + 5.7 years]. Mean treatment duration was 35.6 (30.6) months. Overall, 156 PEG-J procedures were performed, and Nineteen patients (63.3%) had a total of 185 reported complications, 85 of which were peristomal complications. 17 (56.6%) underwent 100 replacement procedures due to complications. The most commonly reported complication for replacement was J-tube dislocation (36%). One patient discontinued treatment after 6 months, due to peripheral neuropathy. Six patients died for causes not related to DLI. PEG-J replacements performed with the "push" method had a higher turnover (5.6 vs. 7.6 mo.), but fewer reported complications (67 vs. 75%).

Conclusion: The overall rate of complications was lower for "push" technique. This result might have been due to a higher replacement turnover that acted as a protective factor.

Keywords: Duodenal levodopa infusion; PEG-J; PEG-J replacement; Parkinson’s disease.

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Conflict of interest statement

Simone Simoni, Pasquale Nigro, Marta Filidei, Giulia Cappelletti, Federico Paolini Paoletti, Danilo Castellani, Mirko Gaggiotti, Lucilla Parnetti declare that they have no competing interest. Nicola Tambasco received a travel grant from Abbvie.

Figures

Fig. 1
Fig. 1
(A) Scheme illustrating the «pull» technique.1 Transesophageal removal of old PEG-J via endoscopy.2 New gastric tube, connected to a guide wire, is pulled from stoma under gastroscopy.3 Endoscopic placement of jejunal tube, (B) Scheme illustrating the «push» technique. 4 Insertion of a guide wire into the lumen of the old PEG-J.5 After deflation ofthe internal bumper, the old PEG-J is removed from the stoma, while the wire is kept in situ.6 New PEG-J is fed over the wire, through stoma, under fluoroscopic guidance.The figure is our own.
See this image and copyright information in PMC

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