Parkinson hastalarında perkütan endoskopik gastrojejunostomi katateri takılan hastalarımızın takibi: Tek merkez deneyimi

Yıl 2022, Cilt: 21 Sayı: 3, 157 - 163, 29.12.2022

Nurten Türkel Küçükmetin Tevfik Solakoğlu

https://doi.org/10.17941/agd.1215967

Öz

Giriş Ve Amaç: Perkütan endoskopik gastrostomi ve perkütan endoskopik gastrojejunostomi enteral nutrisyonda sık kullanılan yöntemlerdir. Son yıllarda ileri evre Parkinson Hastalığı tedavisinde, Levodopa/Karbidopa intestinal jel, perkütan endoskopik gastrojejunostomi ile uygulanmaktadır. Biz, burada Parkinson Hastalığı tedavisi için pull tekniği ile perkütan endoskopik gastrojejunostomi katateri yerleştirilen hastalarımızın takiplerini sunmayı amaçladık. Gereç ve Yöntem: Mayıs 2019 - Mart 2022 yılları arasında perkütan endoskopik gastrojejunostomi takılan 11 hasta incelendi, hastalara ait demografik veriler, işlem sonrası komplikasyonları ve işlem tekrarları değerlendirildi. Bulgular: Perkütan endoskopik gastrojejunostomi takılan hastaların 1’i (%9) kadın, 10’u erkek (%91), yaş ortalaması 63.5 ± 11.2 olup en genç hasta 43 ve en yaşlı hasta 78 yaşındaydı. Onbir hastaya perkütan endoskopik gastrojejunostomi takılması, perkütan endoskopik gastrostomi ve jejunal tüp değişimi olmak üzere toplam 23 endoskopik işlem uygulandı. İlk perkütan endoskopik gastrojejunostomi takılması sonrasında perkütan endoskopik gastrojejunostomi seti ve/veya sadece jejunal katater replasmanı arasındaki ortalama süre 310.5 ± 252.3 gün iken en kısa süre 60 gün, en uzun süre 674 gündü. Replasmanlar arasındaki en kısa süre 26 gün iken, en uzun süre 641 gündü. Hiçbir hastada akut ya da majör komplikasyon görülmezken, jejunal katater tıkanması (3’ü ilaç ile, 1’i king olması) %28.5 oranında en fazla görülen minör komplikasyon olmuştur. Bunu sırasıyla %21.4 (3 olgu) stoma enfeksiyonu, %14.2 (2 hasta) perkütan endoskopik gastrostomi aşınması, %14.2 (2 hasta) jejunal tüpün yanlışlıkla çekilmesi, %7.1 perkütan endoskopik gastrostomi tıkanması (n=1) ve %7.1 (n=1) perkütan endoskopik gastrojejunostomi setinin çekilmesi izlemiştir. Ondört adet toplam advers olay bildirilmiştir. Sonuç: Perkütan endoskopik gastrojejunostomi yerleştirme ve değiştirmesi güvenli bir prosedürdür, ancak perkütan endoskopik gastrojejunostominin uzun süreli kullanımını ve dayanıklılığını araştıran çok az veri bulunmaktadır, replasman için en iyi zamanı ve uzun süreli klinik sonuçları gösteren prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Perkütan endoskopik gastrojejunostomi, PEG-J, komplikasyon, süre

Follow-up of the patients with percutaneous endoscopic gastrojejunustomy catheter placements in Parkinson’s disease: A single center experience

Öz

Background and Aims: Percutaneous endoscopic gastrostomy and percutaneous endoscopic gastrojejunostomy are frequently used methods in enteral nutrition. In recent years, in the treatment of advanced Parkinson's disease Levodopa/Carbidopa intestinal gel is given with percutaneous endoscopic gastrojejunostomy. In this study we aimed to present the follow-up of our patients who had percutaneous endoscopic gastrojejunostomy catheter. Materials and Method: Eleven patients who underwent percutaneous endoscopic gastrojejunostomy placement between March 2019 - May 2022 were examined, demographic data of the patients, complications after the procedure, and procedure repetitions were evaluated. Results: One (9%) of the patients with percutaneous endoscopic gastrojejunostomy were female and 10 were male, mean age was 63.5 ± 11.2 years, the youngest patient was 43 years old, and the oldest was 78 years old. We performed a total of 23 procedures. The mean time between percutaneous endoscopic gastrojejunostomy placement and/or jejunal tube replacement after the first percutaneous endoscopic gastrojejunostomy insertion was 310.5 ± 252.3 days, while the shortest time was 60 days and the longest was 674 days. The shortest time between replacements was 26 days, while the longest was 641 days. Although no serious or major adverse event related to the procedure was observed in any patients, jejunal-catheter occlusion (3 with medication, 1 with king) was the most common minor complication with a rate of 28.5%, followed by stoma infection in 21.4% (n: 3), 14.2% (n: 2) percutaneous endoscopic gastrostomy abrasion, 14.2% (n: 2) accidental removal of jejunal tube, 7.1% percutaneous endoscopic gastrostomy occlusion (n: 1) and 7.1% (n: 1) percutaneous endoscopic gastrojejunostomy set withdrawal. A total of fourteen adverse events were reported. Conclusion: Percutaneous endoscopic gastrojejunostomy placement and replacement are safe procedures, but there isn't any enough data investigating the long-term use and durability of percutaneous endoscopic gastrojejunostomy, prospective studies are needed to demonstrate the best timing for replacement and long-term clinical outcomes.

Anahtar Kelimeler

Percutaneous endoscopic gastrojejunostomy, complication, duration

Kaynakça

• 1. MacFadyen BV, Catalano MF, Raijman I, Ghobrial R. Percutaneous endoscopic gastrostomy with jejunal extension: a new technique. Am J Gastroenterol 1992;87:725-8.
• 2. DeLegge MH. Percutaneous endoscopic gastrostomy. Am J Gastroenterol 2007;102:2620-3.
• 3. Poteet SJ, Holzman MD, Melvin WV, Sharp KW, Poulose BK. Inpatient mortality and length of stay comparison of percutaneous endoscopic gastrostomy and percutaneous endoscopic gastrojejunostomy. J Laparoendosc Adv Surg Tech A 2010;20:587-90.
• 4. Toh Yoon EW, Yoneda K, Nakamura S, Nishihara K. Percutaneous endoscopic transgastric jejunostomy (PEG-J): a retrospective analysis on its utility in maintaining enteral nutrition after unsuccessful gastric feding. BMJ Open Gastroenterol 2016;3:e000098.
• 5. Taki S, Maekita T, Sakata M, et al. Migration of a percutaneous endoscopic gastrojejunostomy tube into the colon with small intestinal telescoping. Clin Endosc 2019;52:616-9.
• 6. Fernandez HH, Boyd JT, Fung VSC, et al. Long-term safety and efficacy of Levodopa-Carbidopa intestinal gel in advanced Parkinson’s Disease. Mov Disord 2018;33:928-36.
• 7. Epstein M, Johnson DA, Hawes R, et al. Long-term PEG-J tube safety in patients with advanced Parkinson’s Disease. Clin Transl Gastroenterol 2016;7:e159.
• 8. Miyaue N, Yabe H, Nomoto M, Nagai M. Effect of percutaneous endoscopic gastrojejunostomy tube placement on levodopa pharmacokinetics. Eur J Clin Pharmacol 2019;75:1753-5.
• 9. Wirdefeldt K, Odin P, Nyholm D. Levodopa–Carbidopa intestinal gel in Patients with Parkinson’s Disease: A systematic review. CNS Drugs 2016;30:381-404.
• 10. Sucullu Karadag Y, Saltoglu T, Erdogan Kucukdagli F, et al. Comprehensive assessment of levodopa-carbidopa intestinal gel for Turkish advanced Parkinson’s disease patients. Turk J Med Sci 2021;51:84-9.
• 11. Cococcia S, Rovedatti L, Lenti MV, et al. Safety and durability of PEG-J: a single-centre experience. Scand J Gastroenterol 2020;55:1377-80.
• 12. Johnson DY, Gallo C J.R, Agassi AM, et al. Percutaneous gastrojejunostomy tubes: Identification of predictors of retrograde jejunal limb migration into the stomach. Clin Imaging 2021;70:93-6.
• 13. Hucl T, Spicak J. Complications of percutaneous endoscopic gastrostomy. Best Pract Res Clin Gastroenterol 2016;30:769-81.
• 14. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014;20:7739-51.
• 15. Zener R, Istl AC, Wanis KN, et al. Thirty-day complication rate of percutaneous gastrojejunostomy and gastrostomy tube insertion using a single-puncture, dual-anchor technique. Clin Imaging 2018;50:104-8.
• 16. Yamashita K, Yube Y, Yamazaki Y, et al. The impact of tube replacement timing during LCIG therapy on PEG-J associated adverse events: a retrospective multicenter observational study. BMC Neurol 2021;21:242.
• 17. Blaise A-S, Baille G, Carrière N, et al. Safety and effectiveness of levodopa-carbidopa intestinal gel for advanced Parkinson's disease: A large single-center study. Rev Neurol (Paris) 2020;176:268-76.
• 18. Simoni S, Nigro P, Filidei M, et al. PEG-J replacement for duodenal levodopa infusion in Parkinson's disease patients: a retrospective study. BMC Neurol 2022;22:25.
• 19. Rus T, Premzl M, Križnar NZ, et al. Adverse effects of levodopa/carbidopa intrajejunal gel treatment: A single-center long-term follow-up study. Acta Neurol Scand Epub 2022 Jul 28.
• 20. Tsuboi T, Watanabe H, Funasaka K, et al Peritonitis after percutaneous endoscopic gastrojejunostomy for levodopa–carbidopa intestinal gel treatment despite concomitant use of gastropexy. Neurology and Clinical Neuroscience 20186:64-6.
• 21. Sensi M, Cossu G, Mancini F, et al. Which patients discontinue? Issues on Levodopa/carbidopa intestinal gel treatment: Italian multicentre survey of 905 patients with long-term follow-up. Parkinsonism Relat Disord 2017;38:90-2.
• 22. Lang AE, Rodriguez RL, Boyd JT, et al. Integrated safety of levodopa-carbidopa intestinal gel from prospective clinical trials. Mov Disord 2016;31:538-46.
• 23. Dixon R, Burton S, Jo Taylor L, Richeson BL, Fang JC. Bezoar formation on percutaneous endoscopic gastrojejunostomy tube causing gastric outlet obstruction and small-intestinal intussusception. VideoGIE 2019;4:416-7.
• 24. Marano M, Pizzicannella M, di Biase L, et al. Jejunal pulling syndrome: a peculiar LCIG complication. Parkinsonism Relat Disord 2018;52:113-4.
• 25. Kalkan IH, Dişibeyaz S, Önder FO, et al. A rare complication of percutaneous endoscopic gastrojejunostomy (PEG-J): duodenal bulb perforation due to retrograde migration. Acta Gastroenterol Belg 2012;75:276-7.