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.

We performed a questionnaire survey targeting members of society of HEQ for accidents and complications in procedures of percutaneous endoscopic gastrostomy. Between 2017 and the first half of 2021, the total number of constructions was 8834, and the total number of replacements was 36535. There were 599 (6.8%) patients with accidents and complications related the construction, and 19 mortalities. Accidents and complications related to replacement occurred 21 (0.057%) patients, and there were no mortalities.

We conducted basic research to identify the optimal material for sealing the puncture site of a rupture-free balloon (RFB) used in PTEG, allowing for subsequent re-puncture. Film dressing, hydrocolloid dressing, and cellophane tape were each applied to the puncture site of the RFB. A 10ml diluted contrast agent solution was injected into the RFB to verify whether the solution leaked out. While leakage occurred with film dressing and hydrocolloid dressing, no leakage was observed with cellophane tape. Sealing the initial puncture site of the RFB with cellophane tape effectively prevented deflation, thereby facilitating successful re-puncture.

【Background】 We conducted a retrospective analysis comparing the role of percutaneous endoscopic gastrostomy (PEG) procedures, as well as changes in complications, over different time periods at Tohoku University Hospital.

【Methods】 We included all cases of PEG procedures performed at our institution from 1997 to 2022. Data on underlying diseases, procedural methods, oral anticoagulant use, and complications were retrospectively extracted from medical records. We divided the cases into two groups: an early period and a late period, and conducted a comparative analysis.

【Results】 A total of 1289 PEG procedures were performed during the entire study period. In the early period, cases in the field of neurology predominated, while in the late period, cases in the field of otolaryngology were more common. The complication rate was 9.7%, the bleeding was higher in the late period (p<0.001). The mortality rate within 30 days was low at 1.0%, and there were no deaths associated with PEG.

【Conclusion】We consider that PEG procedures were performed relatively safely throughout the entire study period at our institution.

【Purpose】To conduct safe and painless percutaneous endoscopic gastrostomy (PEG),, we retrospectively investigated the effects of two intravenously administered sedative agents comparing midazolam and pentazocine.

【Methods】We compared fluctuation of blood pressure, heart rate, arterial oxygen saturation, occurrence of adverse drug events, and sedative and analgesic efficacy during the PEG procedure over a 1-year period when pre-PEG sedative agent had been mainly intravenously administered with midazolam (the midazolam group) and with pentazocine (the pentazocine group).

【Results】In the midazolam group, all 67 patients underwent sedation with midazolam alone. Whereas, in the pentazocine group, 48 patients underwent pentazocine alone, 2 patients with a combination of pentazocine and midazolam, and 1 patient did not undergo sedation. Comparing the two groups, blood pressure significantly decreased in the midazolam group and significantly increased in the pentazocine group. Arterial oxygen saturation significantly decreased after administration of midazolam or pentazocine, and the sedative and analgesic effects were similar in both groups. The incidence of additional treatments for adverse drug events caused by pre-PEG sedation or insufficient sedation was 46.3% in the midazolam group and 15.7% in the pentazocine group, showing a significantly higher incidence of additional treatments in the midazolam group.

【Conclusion】Although the sedative and analgesic effects were similar, sedation with pentazocine was less likely to cause adverse drug events and required less additional treatments than with midazolam; thus, pentazocine appears to be a safer pre-PEG sedation agent.

For elderly people undergoing tube feeding, it may be necessary to discontinue tube feeding due to a decline in physical function. We conducted retrospective clinical research of the outcomes of the patients who underwent tube feeding through gastrostomy. The number of patients who underwent endoscopic gastrostomy for 5 years from 2017 to 2021 was 50 cases (male; 18, female; 32), and then 20 cases survived and 30 cases were dead at the end of May 2022. 20 patients of the deceased cases received tube feeding for more than 3 months and could be tracked the progress. In addition, among patients who underwent PEG at another hospital and were subsequently followed up at our hospital, we found 14 cases in which tube feeding was discontinued or the patient died during the same period, and the progress could be followed. We investigated and tabulated the clinical course of these 34 cases. Tube feeding was discontinued in 26 cases (76.5%) during the course of hospitalization. The main reason was a decrease in SpO2, followed by fever, an increase in sputum, vomiting, and diarrhea. The average time from cessation of feeding to death was 25.8 days (min.; 1 day, max.; 138 days); meanwhile, PPN or subcutaneous infusion was performed. In addition, O-PNI during the period of tube feeding discontinuation was observed significant decrease compared to during the course of treatment. The cause of death was diagnosed as aspiration pneumonia in 23 cases (67.6%), senility in 4 cases (11.8%), heart failure in 3 cases (8.8%), pneumonia in 2 cases (5.9%), acute respiratory failure in 1 case (2.9%), and others in 1 case. If a patient receiving tube feeding shows signs of decline in physical function, including a decrease of O-PNI, it may be necessary to consider measures for the final stage of life, such as reducing or discontinuing tube feeding.