Journal
PARKINSONISM & RELATED DISORDERS
Volume 89, Issue -, Pages 34-37Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.parkreldis.2021.06.022
Keywords
Levodopa carbidopa intestinal gel; Radiologically inserted gastrostomy; per-oral image guided gastrostomy; Percutaneous endoscopic gastrostomy; Parkinson's disease
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The study presents a case series of 32 patients undergoing PIG-J insertion for LCIG therapy in a single center. The procedure, performed under local anesthesia, involves fluoroscopy-guided gastric puncture followed by secure fixation of the gastrostomy tube and placement of the gastrojejunal extension.
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.
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