Julian Cheron1, Jacques Deviere2, Frederic Supiot3, Asuncion Ballarin4, Pierre Eisendrath2, Emmanuel Toussaint2, Vincent Huberty2, Carmen Musala2, Daniel Blero2, Arnaud Lemmers2, André Van Gossum5, Marianna Arvanitakis5. 1. Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. 2. Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. 3. Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. 4. Nutrition Team, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. 5. Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Nutrition Team, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Abstract
BACKGROUND: Continuous delivery to the jejunum of levodopa-carbidopa is a promising therapy in patients with advanced Parkinson's disease, as it reduces motor fluctuation. Percutaneous endoscopic gastrostomy and jejunal tube (PEG-J) placement is a suitable option for this. However, studies focused in PEG-J management are lacking. OBJECTIVES: We report our experience regarding this technique, including technical success, adverse events and outcomes, in patients with advanced Parkinson's disease. METHODS: Twenty-seven advanced Parkinson's disease patients (17 men, median age: 64 years, median disease duration: 11 years) were included in a retrospective study from June 2007 to April 2015. The median follow-up period was 48 months (1-96). RESULTS: No adverse events were noted during and after nasojejunal tube insertion (to assess treatment efficacy). After a good therapeutic response, a PEG-J was placed successfully in all patients. The PEG tube was inserted according to Ponsky's method. The jejunal extension was inserted during the same procedure in all patients. Twelve patients (44%) experienced severe adverse events related to the PEG-J insertion, which occurred after a median follow-up of 15.5 months. Endoscopy was the main treatment modality. Patients who experienced severe adverse events had a higher comorbidity score (p = 0.011) but were not older (p = 0.941) than patients who did not. CONCLUSIONS: While all patients responded well to levodopa-carbidopa regarding neurological outcomes, gastro-intestinal severe adverse events were frequent and related to comorbidities. Endoscopic treatment is the cornerstone for management of PEG-J related events. In conclusion, clinicians and endoscopists, as well as patients, should be fully informed of procedure-related adverse events and patients should be followed in centres experienced in their management.
BACKGROUND: Continuous delivery to the jejunum of levodopa-carbidopa is a promising therapy in patients with advanced Parkinson's disease, as it reduces motor fluctuation. Percutaneous endoscopic gastrostomy and jejunal tube (PEG-J) placement is a suitable option for this. However, studies focused in PEG-J management are lacking. OBJECTIVES: We report our experience regarding this technique, including technical success, adverse events and outcomes, in patients with advanced Parkinson's disease. METHODS: Twenty-seven advanced Parkinson's diseasepatients (17 men, median age: 64 years, median disease duration: 11 years) were included in a retrospective study from June 2007 to April 2015. The median follow-up period was 48 months (1-96). RESULTS: No adverse events were noted during and after nasojejunal tube insertion (to assess treatment efficacy). After a good therapeutic response, a PEG-J was placed successfully in all patients. The PEG tube was inserted according to Ponsky's method. The jejunal extension was inserted during the same procedure in all patients. Twelve patients (44%) experienced severe adverse events related to the PEG-J insertion, which occurred after a median follow-up of 15.5 months. Endoscopy was the main treatment modality. Patients who experienced severe adverse events had a higher comorbidity score (p = 0.011) but were not older (p = 0.941) than patients who did not. CONCLUSIONS: While all patients responded well to levodopa-carbidopa regarding neurological outcomes, gastro-intestinal severe adverse events were frequent and related to comorbidities. Endoscopic treatment is the cornerstone for management of PEG-J related events. In conclusion, clinicians and endoscopists, as well as patients, should be fully informed of procedure-related adverse events and patients should be followed in centres experienced in their management.
Authors: E Toussaint; A Van Gossum; A Ballarin; O Le Moine; M Estenne; C Knoop; J Devière; M Arvanitakis Journal: Endoscopy Date: 2012-07-25 Impact factor: 10.093
Authors: M M Ma; E A Semlacher; R N Fedorak; E A Lalor; D R Duerksen; R W Sherbaniuk; C E Chalpelsky; D C Sadowski Journal: Gastrointest Endosc Date: 1995-05 Impact factor: 9.427
Authors: Sanne Dam-Larsen; Bahman Darkahi; Arne Glad; Dagfinn Gleditsch; Lena Gustavsson; Jorma Halttunen; Karl Erik Johansson; Andreas Pischel; Ola Reiertsen; Björn Törnqvist; Hubert Zebski Journal: Scand J Gastroenterol Date: 2015-06-17 Impact factor: 2.423