Use of enteral access for continuous delivery of levodopa-carbidopa in patients with advanced Parkinson's disease

J Cheron,F Supiot,A Lemmers,V Huberty,J Deviere,D Blero,M Arvanitakis,E Toussaint,A Van Gossum,C Musala,P Eisendrath,A Ballarin

doi:10.1016/j.nupar.2016.01.080

J Cheron, F Supiot + Show 10 more

Open Access

https://doi.org/10.1016/j.nupar.2016.01.080

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Abstract

Introduction and aim 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 placement is a suitable option for this. However, studies focused in percutaneous endoscopic gastrostomy and jejunal tube management are lacking. We report our experience regarding this technique, including technical success, adverse events and outcomes, in patients with advanced Parkinson's disease. Material and methods Twenty-seven advanced patients with Parkinson's disease (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 months]. Results No adverse event was noted during and after nasojejunal tube insertion (to assess treatment efficacy). After a good therapeutic response, a percutaneous endoscopic gastrostomy and jejunal tube was placed successfully in all patients. The percutaneous endoscopic gastrostomy tube was inserted according to the 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 percutaneous endoscopic gastrostomy and jejunal tube 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 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, severe adverse events were frequent and related with comorbidities. Endoscopic treatment is the cornerstone for management of percutaneous endoscopic gastrostomy and jejunal tube-related events. In conclusion, clinicians, 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.

Highlights

Parkinson’s disease is a neurodegenerative disorder resulting from the death of dopamine neurons in the substantia nigra pars compacta with resultant depletion of striatal dopamine leading to motor, behavioural and/or cognitive symptoms.1Levodopa, the precursor of dopamine, is the gold standard treatment
Twelve patients (44%) experienced severe adverse events related to the Percutaneous endoscopic gastrostomy and jejunal tube (PEG-J) insertion, which occurred after a median follow-up of 15.5 months
Endoscopic treatment is the cornerstone for management of PEG-J related events

Summary

Introduction

Parkinson’s disease is a neurodegenerative disorder resulting from the death of dopamine neurons in the substantia nigra pars compacta with resultant depletion of striatal dopamine leading to motor, behavioural and/or cognitive symptoms.1Levodopa, the precursor of dopamine, is the gold standard treatment. PEG-J insertion techniques, occurrence and management of adverse events should be studied in detail, regarding this particular patient group. Available data about adverse events experienced by patients receiving enteral levodopa-carbidopa do not focus on modalities regarding PEG-J insertion but, report that the majority of adverse events (63%) are related to the infusion system.. Objectives: We report our experience regarding this technique, including technical success, adverse events and outcomes, in patients with advanced Parkinson’s disease. Twelve patients (44%) experienced severe adverse events related to the PEG-J insertion, which occurred after a median follow-up of 15.5 months. Conclusions: While all patients responded well to levodopa-carbidopa regarding neurological outcomes, gastro-intestinal severe adverse events were frequent and related to comorbidities. 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

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