The use of enteral access for continuous delivery of levodopa‐carbidopa in patients with advanced Parkinson's disease. Issue 1 (1st February 2017) - Cheron, Julian
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.