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

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

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