Baig, F; Boca, M; Mooney, L; Cheminais, L; Selikhova, M; Rolinski, M; Szewczyk-Krolikowski, K; Collin, N; Whone, A
(2021)
Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous.
Parkinsonism Relat Disord, 89.
pp. 34-37.
ISSN 1873-5126
https://doi.org/10.1016/j.parkreldis.2021.06.022
SGUL Authors: Baig, Fahd
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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.
Item Type: | Article |
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Additional Information: | © 2021. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ |
Keywords: | Levodopa carbidopa intestinal gel, Parkinson's disease, Percutaneous endoscopic gastrostomy, Radiologically inserted gastrostomy, per-oral image guided gastrostomy, 1103 Clinical Sciences, 1702 Cognitive Sciences, Neurology & Neurosurgery |
SGUL Research Institute / Research Centre: | Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
Journal or Publication Title: | Parkinsonism Relat Disord |
ISSN: | 1873-5126 |
Language: | eng |
Publisher License: | Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0 |
PubMed ID: | 34218045 |
Go to PubMed abstract | |
URI: | https://openaccess.sgul.ac.uk/id/eprint/113445 |
Publisher's version: | https://doi.org/10.1016/j.parkreldis.2021.06.022 |
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