Research Article
BibTex RIS Cite

Short and long-term safety and durability of PEG-J tube in jejunal levodopa infusion in patients with Parkinson's disease

Year 2023, Volume: 4 Issue: 5, 389 - 394, 27.10.2023
https://doi.org/10.47582/jompac.1332644

Abstract

Aims: To investigate PEG-J related adverse events and tube durability in patients with Parkinson’s disease who underwent PEG-J procedure for jejunal drug infusion.
Methods: PEG-J implanted patients, who were planned jejunal levodopa infusion, were included in the study. The demographic characteristics of the patients, tube durability, tube replacement, reason for tube replacement, number of procedures, and adverse events related to procedures were retrospectively analyzed.
Results: Thirty-four patients with a mean age of 65.7±9.8 years included in the study. The mean total PEG-J follow-up period of the patients was 33.6±21.1 months. Functions of PEG-J tubes were preserved in 82.5% at 6 months, 78.4% at 12 months, and 65.2% at 18 months. Twenty-one (% 61,8) patients required at least one PEG-J replacement. Of the PEG-J replacements, 90.4% were due to device-related advers events. A total of 29 procedure or stoma related adverse events occurred in 21 (61.8%) patients, and a total of 28 PEG-J tube related adverse events occurred in 19 (55.9%) patients. A total of 6 (17.5%) early procedure-related adverse events (acute abdomen and peritonitis, prolonged bleeding, stoma leakage, stoma infection) were observed, all occurring in the first 7 days. Twenty-three (67.6%) stoma-related late adverse events (stoma leakage, stoma infection, abscess) were detected. Two patients who developed peritonitis were successfully treated with conservative treatments.
Conclusion: PEG-J used for drug application is a safe method and can be used for a long time without the need for frequent replacement. Most of advers events can be managed with conservative treatments.

References

  • Arvanitakis M, Gkolfakis P, Despott EJ, et al. Endoscopic management of enteral tubes in adult patients - part 1: definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021;53(1):81-92.
  • Deliwala SS, Chandan S, Kumar A, et al. Direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) technical success and outcomes: Systematic review and meta-analysis. Endosc Int Open. 2022;10(4): E488-E520. doi:10.1055/a-1774-4736
  • Kamel WA, Al-Hashel JY. LCIG in treatment of non-motor symptoms in advanced Parkinson’s disease: review of literature. Brain Behav. 2020;10(9): e01757. doi:10.1002/brb3.1757
  • Blaise AS, 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(4):268-276.
  • Antonini A, Odin P, Pahwa R, et al. The long-term impact of levodopa/carbidopa intestinal gel on ‘off’-time in patients with advanced Parkinson’s disease: a systematic review. Adv Ther. 2021;38(6):2854-2890.
  • Othman AA, Chatamra K, Mohamed ME, et al. Jejunal infusion of levodopa-carbidopa intestinal gel versus oral administration of levodopa-carbidopa tablets in Japanese subjects with advanced Parkinson’s disease: pharmacokinetics and pilot efficacy and safety. Clin Pharmacokinet. 2015;54(9):975-984.
  • Fernandez HH, Odin P. Levodopa-carbidopa intestinal gel for treatment of advanced Parkinson’s disease. Curr Med Res Opin. 2011;27(5):907-919.
  • Cococcia S, Rovedatti L, Lenti MV, Pozzi L, De Grazia F, Di Sabatino A. Safety and durability of PEG-J: a single-centre experience. Scand J Gastroenterol. 2020;55(11):1377-1380.
  • Udd M, Lyytinen J, Eerola-Rautio J, et al. Problems related to levodopa-carbidopa intestinal gel treatment in advanced Parkinson’s disease. Brain Behav. 2017;7(7): e00737. doi:10.1002/brb3.737
  • Viljaharju V, Mertsalmi T, Pauls KAM, et al. Single-center study of 103 consecutive Parkinson’s disease patients with levodopa-carbidopa intestinal gel. Mov Disord Clin Pract. 2021;9(1):60-68.
  • Standaert DG, Rodriguez RL, Slevin JT, et al. Effect of levodopa-carbidopa intestinal gel on non-motor symptoms in patients with advanced Parkinson’s disease. Mov Disord Clin Pract. 2017;4(6):829-837.
  • Lopiano L, Modugno N, Marano P, et al. Motor and non-motor outcomes in patients with advanced Parkinson’s disease treated with levodopa/carbidopa intestinal gel: final results of the GREENFIELD observational study. J Neurol. 2019;266(9):2164-2176.
  • 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(3): e159. doi:10.1038/ctg.2016.19
  • Cheron J, Deviere J, Supiot F, et al. The use of enteral access for continuous delivery of levodopa-carbidopa in patients with advanced Parkinson’s disease. United European Gastroenterol J. 2017;5(1):60-68.
  • Ishibashi Y, Shimo Y, Yube Y, et al. Technique and outcome of percutaneous endoscopic transgastric jejunostomy for continuous infusion of levodopa-carbidopa intestinal gel for treatment of Parkinson’s disease. Scand J Gastroenterol. 2019;54(6):787-792.
  • 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(1):242.
  • 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(1):25.
  • 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. 2022;146(5):537-544.
  • Zopf Y, Konturek P, Nuernberger A, et al. Local infection after placement of percutaneous endoscopic gastrostomy tubes: a prospective study evaluating risk factors. Can J Gastroenterol. 2008;22(12):987-991.
  • Yamanishi Y, Choudhury ME, Yoshida A, et al. Impact of intestinal bacteria on levodopa pharmacokinetics in LCIG therapy. Mov Disord Clin Pract. 2022;9(3):362-368.
  • de Vries T, de Ruiter A, Westendorp A, van Zeijl J. Microorganisms and complaints in outpatients with a percutaneous endoscopic gastrostomy catheter. Am J Infect Control. 2015;43(8):802-804.
  • Wirth R, Bauer J, Sieber C. Necrotizing Candida infection after percutaneous endoscopic gastrostomy: a fatal and rare complication. JPEN J Parenter Enteral Nutr. 2008;32(3):285-287.

Jejunal levodopa infüzyonu alan Parkinson hastalarında PEG-J tüpünün kısa ve uzun dönem güvenilirliği ve devamlılığı

Year 2023, Volume: 4 Issue: 5, 389 - 394, 27.10.2023
https://doi.org/10.47582/jompac.1332644

Abstract

Amaç: Jejunal ilaç infüzyonu için PEG-J prosedürü uygulanan Parkinson hastalarında PEG-J ile ilişkili advers olayları ve tüp devamlılığını araştırmak.
Gereç ve Yöntem: Çalışmaya jejunal Levodopa infüzyonu planlanan PEG-J tüpü takılmış hastalar dahil edildi. Hastaların demografik özellikleri, tüp devamlılığı, tüp değişimi, tüp değiştirme nedeni, işlem sayısı ve işleme bağlı advers olaylar retrospektif olarak incelendi.
Bulgular: Çalışmaya yaş ortalaması 65.7±9.8 olan 34 hasta dahil edildi. Hastaların ortalama toplam PEG-J takip süresi 33.6±21.1 aydı. PEG-J tüplerinin fonksiyonları 6. ayda %82.5, 12. ayda %78.4 ve 18. ayda %65.2 oranında korunmuştu. Yirmi bir (% 61.8) hastada en az bir PEG-J replasmanı gerekti. PEG-J değişimlerinin %90.4'ü cihazla ilgili nedenlerden kaynaklanıyordu. Yirmi bir (%61.8) hastada prosedür veya stoma ile ilgili toplam 29 advers olay meydana geldi ve 19 (%55.9) hastada PEG-J tüpü ile ilgili toplam 28 advers olay meydana geldi. İşlemle ilgili toplam 6 (%17.5) erken advers olay (akut karın ve peritonit, uzamış kanama, stoma kaçağı, stoma enfeksiyonu) gözlendi ve tümü ilk 7 gün içinde meydana geldi. Yirmi üç (%67.6) stomaya bağlı geç advers olay (stoma kaçağı, stoma enfeksiyonu, apse) tespit edildi. Peritonit gelişen iki hasta konservatif tedavilerle başarıyla tedavi edildi.
Sonuç: İlaç uygulaması için kullanılan PEG-J güvenli bir yöntemdir ve sık tüp değiştirilmesi gerekmeden uzun süre kullanılabilir. Advers olayların çoğu konservatif yöntemlerle tedavi edilebilir.
Anahtar kelimeler: PEG-J, advers olaylar, Parkinson hastalığı, jejunal ilaç infüzyonu

References

  • Arvanitakis M, Gkolfakis P, Despott EJ, et al. Endoscopic management of enteral tubes in adult patients - part 1: definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021;53(1):81-92.
  • Deliwala SS, Chandan S, Kumar A, et al. Direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) technical success and outcomes: Systematic review and meta-analysis. Endosc Int Open. 2022;10(4): E488-E520. doi:10.1055/a-1774-4736
  • Kamel WA, Al-Hashel JY. LCIG in treatment of non-motor symptoms in advanced Parkinson’s disease: review of literature. Brain Behav. 2020;10(9): e01757. doi:10.1002/brb3.1757
  • Blaise AS, 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(4):268-276.
  • Antonini A, Odin P, Pahwa R, et al. The long-term impact of levodopa/carbidopa intestinal gel on ‘off’-time in patients with advanced Parkinson’s disease: a systematic review. Adv Ther. 2021;38(6):2854-2890.
  • Othman AA, Chatamra K, Mohamed ME, et al. Jejunal infusion of levodopa-carbidopa intestinal gel versus oral administration of levodopa-carbidopa tablets in Japanese subjects with advanced Parkinson’s disease: pharmacokinetics and pilot efficacy and safety. Clin Pharmacokinet. 2015;54(9):975-984.
  • Fernandez HH, Odin P. Levodopa-carbidopa intestinal gel for treatment of advanced Parkinson’s disease. Curr Med Res Opin. 2011;27(5):907-919.
  • Cococcia S, Rovedatti L, Lenti MV, Pozzi L, De Grazia F, Di Sabatino A. Safety and durability of PEG-J: a single-centre experience. Scand J Gastroenterol. 2020;55(11):1377-1380.
  • Udd M, Lyytinen J, Eerola-Rautio J, et al. Problems related to levodopa-carbidopa intestinal gel treatment in advanced Parkinson’s disease. Brain Behav. 2017;7(7): e00737. doi:10.1002/brb3.737
  • Viljaharju V, Mertsalmi T, Pauls KAM, et al. Single-center study of 103 consecutive Parkinson’s disease patients with levodopa-carbidopa intestinal gel. Mov Disord Clin Pract. 2021;9(1):60-68.
  • Standaert DG, Rodriguez RL, Slevin JT, et al. Effect of levodopa-carbidopa intestinal gel on non-motor symptoms in patients with advanced Parkinson’s disease. Mov Disord Clin Pract. 2017;4(6):829-837.
  • Lopiano L, Modugno N, Marano P, et al. Motor and non-motor outcomes in patients with advanced Parkinson’s disease treated with levodopa/carbidopa intestinal gel: final results of the GREENFIELD observational study. J Neurol. 2019;266(9):2164-2176.
  • 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(3): e159. doi:10.1038/ctg.2016.19
  • Cheron J, Deviere J, Supiot F, et al. The use of enteral access for continuous delivery of levodopa-carbidopa in patients with advanced Parkinson’s disease. United European Gastroenterol J. 2017;5(1):60-68.
  • Ishibashi Y, Shimo Y, Yube Y, et al. Technique and outcome of percutaneous endoscopic transgastric jejunostomy for continuous infusion of levodopa-carbidopa intestinal gel for treatment of Parkinson’s disease. Scand J Gastroenterol. 2019;54(6):787-792.
  • 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(1):242.
  • 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(1):25.
  • 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. 2022;146(5):537-544.
  • Zopf Y, Konturek P, Nuernberger A, et al. Local infection after placement of percutaneous endoscopic gastrostomy tubes: a prospective study evaluating risk factors. Can J Gastroenterol. 2008;22(12):987-991.
  • Yamanishi Y, Choudhury ME, Yoshida A, et al. Impact of intestinal bacteria on levodopa pharmacokinetics in LCIG therapy. Mov Disord Clin Pract. 2022;9(3):362-368.
  • de Vries T, de Ruiter A, Westendorp A, van Zeijl J. Microorganisms and complaints in outpatients with a percutaneous endoscopic gastrostomy catheter. Am J Infect Control. 2015;43(8):802-804.
  • Wirth R, Bauer J, Sieber C. Necrotizing Candida infection after percutaneous endoscopic gastrostomy: a fatal and rare complication. JPEN J Parenter Enteral Nutr. 2008;32(3):285-287.

Details

Primary Language English
Subjects Gastroenterology and Hepatology
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

İlyas TENLİK

Ömer ÖZTÜRK 0000-0002-4545-7149

Derya ARI 0000-0001-8024-781X

Orhan COŞKUN 0000-0002-3124-9517

Hasan Tankut KÖSEOĞLU 0000-0002-4819-4460

Emin ALTIPARMAK 0000-0001-8900-9498

Yeşim SÜCÜLLÜ KARADAĞ 0000-0003-0188-5245

Early Pub Date October 26, 2023
Publication Date October 27, 2023
Published in Issue Year 2023 Volume: 4 Issue: 5

Cite

AMA TENLİK İ, ÖZTÜRK Ö, ARI D, COŞKUN O, KÖSEOĞLU HT, ALTIPARMAK E, SÜCÜLLÜ KARADAĞ Y. Short and long-term safety and durability of PEG-J tube in jejunal levodopa infusion in patients with Parkinson’s disease. J Med Palliat Care / JOMPAC / jompac. October 2023;4(5):389-394. doi:10.47582/jompac.1332644

TR DİZİN ULAKBİM and International Indexes (1d)

Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]



google-scholar.png


crossref.jpg

f9ab67f.png

asos-index.png


COPE.jpg

icmje_1_orig.png

cc.logo.large.png

ncbi.png

ORCID_logo.png

pn6krf5.jpg


Our journal is in TR-Dizin, DRJI (Directory of Research Journals Indexing, General Impact Factor, Google Scholar, Researchgate, CrossRef (DOI), ROAD, ASOS Index, Turk Medline Index, Eurasian Scientific Journal Index (ESJI), and Turkiye Citation Index.

EBSCO, DOAJ, OAJI and ProQuest Index are in process of evaluation. 

Journal articles are evaluated as "Double-Blind Peer Review"