1. Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous.
- Author
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Baig F, Boca M, Mooney L, Cheminais L, Selikhova M, Rolinski M, Szewczyk-Krolikowski K, Collin N, and Whone A
- Subjects
- Aged, Drug Combinations, Female, Gastrostomy adverse effects, Gastrostomy methods, Gels, Humans, Jejunum surgery, Male, Middle Aged, Outcome and Process Assessment, Health Care, Surgery, Computer-Assisted, Antiparkinson Agents administration & dosage, Carbidopa administration & dosage, Digestive System Surgical Procedures adverse effects, Digestive System Surgical Procedures methods, Levodopa administration & dosage, Parkinson Disease drug therapy
- Abstract
Background: Procedural aspects and complications of gastrojejunostomy insertion are important considerations in the use of levodopa-carbidopa intestinal gel therapy (LCIG) and may limit uptake. We describe our experience of using per-oral image guided gastrojejunostomy (PIG-J) which avoids the need for endoscopy and routine sedation in percutaneous endoscopic gastrojejunostomy (PEG-J) and allows more secure tube placement than radiologically inserted gastrojejunostomy techniques., Methods: We describe a case series of 32 patients undergoing PIG-J insertion for LCIG therapy in a single centre. Under local anaesthetic, a fluoroscopy-guided gastric puncture allows access for the guidewire which is then used to pull through the gastrostomy tube allowing for secure fixation, followed by placement of the gastrojejunal extension., Results: Between December 2015 to April 2020, 32/34 patients referred for PIG-J underwent this procedure successfully, 2 cases unsuccessful due to technical considerations. One patient developed delirium following successful implantation. Ten patients (31%) required a replacement tube due to blockage or displacement within the first 12 months of placement, including 2 patients who needed more than one replacement. Minor complications occurred in 10 other patients (31%), including infection (9 patients); a small haematoma not requiring intervention who later developed an infection (1 patient); and peri-stomal acid leakage (1 patient)., Conclusion: In summary, PIG-J insertion is safe with a similar complication rate to traditional PEG-J, well tolerated and effective for use in LCIG administration. This may widen access to LCIG for PD patients who may not be suitable or unable to tolerate PEG-J., (Copyright © 2021 Elsevier Ltd. All rights reserved.)
- Published
- 2021
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