Long-term PEG-J Tube for Treatment Delivery in Patients With Advanced Parkinsonʼs Disease

Abstract

Introduction: Duodopa® is a modern treatment for advanced stages of Parkinson's disease (PD) administrated via PEG-J by means of a tube connected to an external pump. Duodopa® is delivered continuously in small quanta preventing large plasma level fluctuations and thus suppressing disabling motor complications related to oral treatment in advanced stages of PD. Methods: We retrospectively analyzed records from 51 PD patients (23 males; mean age 66 (SD) 8 years) treated in the Movement Disorders Center in Prague with Duodopa® PEG-J. Time on PEG-J, weight, Duodopa® dose and adverse effects were analyzed. Results: The mean time on PEG-J was 3.7 (IQR 0.6 - 3.2) years. Adverse effects occurred in 36 (71%) patients commonly manifested by inflammation around the PEG-J stoma (17 pts). Other common side effects were technical problems with the pump (13 pts), excessive tissue granulation (7 pts) or tube dislocation (6 pts). The overall mortality was 24%, with no relationship to PEG-J complications. Out of the surviving patients, treatment was stopped in 11 (23%) due to lack of efficacy and in 4 (8%) due to intolerable side effects related to the PEG-J. In addition, there was an interaction between the change of the Duodopa® dose, change in body weight and PEG-J duration (p=0.023) (Figure 1).FigureConclusion: Despite the relatively high frequency of side effects during Duodopa® treatment, the PEG-J was well tolerated in the majority of PD patients during a relatively long follow-up. Surprisingly, the Duodopa daily consumption co-varied with body weight in different ways according to various durations of the treatment.