Percutaneous Endoscopic Gastro-Jejunostomy (PEGJ): Could Drug Administation be the Only Indication for Insertion? The Levodopa/Carbidopa Infusion Treatment Experience. A Retrospective Evaluation of the Method

Abstract

Enteral feeding is the preferred means of nutritional support in patients unable to eat normally. Percutaneous endoscopic gastro-jejunostomy (PEGJ) is widely used in such cases. It is also accepted that medication will be administered through the tube. In patients with severe Parkinson’s disease, a continuous delivery system of levodopa/carbidopa, formulated as a gel suspension (Duodopa®), reaches the small intestine through a jejunostomy and represents an alternative treatment method. The continuous release results in less variability in levodopa serum concentrations and fewer motor fluctuations and dyskinesias compared to oral administration. The method requires a very good collaboration between neurologists and gastroenterologists and is used in specializing centers in patients as mentioned with severe disease. A modified percutaneous endoscopic gastrostomy (PEG) kit is placed under sedation. This allows the passage of a pig tail catheter which is advanced to the jejunum and a portable pump is attached on it through a specially designed tubing system. This is the only case, known to us, where PEGJ is inserted for drug administration. We present our experience of nine cases (7 males, 2 females, mean age 72.4 years) with a follow up of up to five years. In three patients the tubing system had to be changed; the first it was accidentally pulled out, the second because of bezoar formation around the intragastric part of the tube and the third because of knot formation at the intragastric part of the jejunal tube. At the end of this five year period, all patients agreed that the neurological benefit was welcome and they had all come in terms with the undoubted difficulties the procedure causes.