Operation of the percutaneous endoscopic gastrostomy-jejunostomy tube without endoscopy in patients with Parkinson's disease on levodopa-carbidopa intestinal gel infusion therapy

Yohei Mukai; Hiroyuki Toyoda; Kenji Miyama; Yuji Takahashi

doi:10.1016/j.prdoa.2020.100079

Operation of the percutaneous endoscopic gastrostomy-jejunostomy tube without endoscopy in patients with Parkinson's disease on levodopa-carbidopa intestinal gel infusion therapy

Clin Park Relat Disord. 2020 Nov 17:3:100079. doi: 10.1016/j.prdoa.2020.100079. eCollection 2020.

Authors

Yohei Mukai¹, Hiroyuki Toyoda², Kenji Miyama², Yuji Takahashi¹

Affiliations

¹ Department of Neurology, National Center Hospital, Parkinson's Disease & Movement Disorders Center, National Center of Neurology and Psychiatry, Japan.
² Department of Surgery, National Center Hospital, National Center of Neurology and Psychiatry, Japan.

Abstract

Introduction: Tube-related adverse events (AEs) occur frequently in patients with Parkinson's disease (PD) receiving levodopa-carbidopa intestinal gel therapy. Endoscopy has become evasive since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to evaluate methods that use the percutaneous endoscopic gastrostomy-jejunostomy (PEG-J) tubes without endoscopy.

Methods: We included 19 patients in this study. The contrast agent was injected into the PEG-J tube to clarify the AEs related to the use of the tube. When the kink of the PEG-J tube was found, it was pulled approximately 5-10 cm. When placing or replacing the PEG-J tube, the percutaneous endoscopic gastrostomy (PEG) tube was pushed into the gastrostomy hole to bring its tip closer to the pylorus before a new PEG-J tube was inserted into it.

Results: The mean patient age was 63.1 ± 9.9 years, while the mean duration of PD was 16.7 ± 6.3 years. Tube-related AEs included PEG-J tube kinks (32 events), connector failures (20 events), and PEG-J tube entanglements without/with bezoars (9 events/5 events). All PEG-J tube kinks were resolved by tube manipulation with a fluoroscopic guide. In 66 of 85 events (77.6%), the PEG-J tube was placed or replaced without endoscopy. We believe that the use of the antispasmodic agent just before PEG-J operation reduced this rate.

Conclusion: Our methods were able to resolve most AEs associated with PEG-J tube use without endoscopy.

Keywords: Fluoroscopy; Kink; Levodopa-carbidopa intestinal gel; PEG-J tube; Parkinson’s disease.