2024 Volume 27 Issue 1 Pages 1-7
Background: Levodopa/carbidopa intestinal gel (LCIG) therapy is widely used for advanced Parkinson’s disease, and percutaneous endoscopic gastrostomy-jejunostomy (PEG-J) is considered effective for its delivery. However, the difficulty of the PEG-J procedure and the device-related complication rate are relatively high. In this study, the outcomes of patients who underwent PEG-J for LCIG therapy were examined.
Methods: Eight patients (mean age 72.9±5.6 years; male/female 1/3; time from onset to PEG-J construction 13.4±2.3 years) who underwent PEG-J for LCIG therapy at Tokai University Hospital from January 1, 2020 to July 31, 2023, were included in this retrospective study. Two methods of PEG-J construction were used: in Group A, using forceps, the tip of the tube was guided into the duodenum and placed beyond the ligament of Treitz; and in Group B, the fixation plate was pressed against the pyloric ring and guided by a guide wire to the transverse part of the duodenum.
Results: LCIG therapy was effective in all patients, but complications were observed in 6 patients (75.0%). PEG-J creation time was shorter in Group B than in Group A, but not significantly (p = 0.057). There was no difference in the PEG-J creation time by placement site. Complications identified after PEG-J construction included gastrostomy dermatitis (6 cases), tube flexion (4 cases), spontaneous evacuation (2 cases), and deep tube insertion (1 case). LCIG therapy was discontinued in three patients; two were converted to gastrostomy for nutritional support due to difficulty with oral intake, and one was removed due to ulceration around the gastrostomy.
Conclusion: In PEG-J construction, it was efficient to have the fixation plate close to the pyloric ring and then guided under a guide wire into the duodenum. Despite the high incidence of complications such as perigastrostomy dermatitis and tube flexion, LCIG therapy using PEG-J was useful during the clinical course of Parkinson’s disease.
