Best practice in placement of percutaneous endoscopic gastrostomy with jejunal extension tube for continuous infusion of levodopa carbidopa intestinal gel in the treatment of selected patients with Parkinson’s disease in the Nordic region

Abstract

LCIG treatment administered through PEG/J-tubes gives a significant increase in quality of life for selected patients with advanced Parkinson's disease. Although minor complications are common, serious complications are infrequent, and the tube insertion procedures have a good safety record. Further development of delivery systems and evaluation of approaches designed to reduce the demand for redo endoscopy are required.

Levodopa-entacapone-carbidopa intestinal gel in Parkinson's disease: A randomized crossover study

“…The study product, LECIG (levodopa [20 mg/mL], entacapone [20 mg/mL], and carbidopa monohydrate [5 mg/mL]; LECIGon; LobSor Pharmaceutical AB, Knivsta, Sweden), was administered via the same gastrojejunostomy tube as used for LCIG infusion . LECIG is contained in 50‐mL syringes attached to an infusion pump (Cane, Italy), together measuring 55 × 150 mm (Fig.…”

Levodopa-carbidopa enteral suspension in advanced Parkinson’s disease: clinical evidence and experience

“…Due to the high percentage of AEs associated with device insertion, a gastroenterologist/surgeon experienced in the establishment of the PEG-J and an experienced post-procedural care team including specialist PD nurses could be expected to minimize the risk of complications of device insertion and tubing problems such as twisting, kinking or knotting [Negreanu et al 2010;Krones et al 2012;Pedersen et al 2012;Stathis et al 2014;Dam-Larsen et al 2015;DelHoyo-Francisco et al 2015].…”

“…LCIG is a carboxmethylcellulose aqueous gel containing 20 mg levodopa and 5 mg carbidopa monohydrate per ml [AbbVie Ltd., 2016]. LCIG is delivered directly to the proximal jejunum via a percutaneous endoscopic gastrostomy tube with a jejunal extension (PEG-J) connected to a portable, programmable infusion pump (CADD Legacy ® Duodopa Pump, Smiths Medical, St Paul, MN, USA), including a cassette that contains the gel [Dam-Larsen et al 2015]. Continuous infusion of LCIG bypasses gastric emptying, and thus avoids a potential cause of inadequate levodopa absorption .…”

Levodopa‐carbidopa intestinal gel: ‘dismantling the road blocks of a journey’

“…Positioning is typically achieved with a so‐called ‘pull’ technique, which requires the recurrent use of an endoscope in optimising the PEG–J position. The adoption of a ‘push’ technique has the advantage of only one endoscopic introduction, thus minimising the risk of complications . A radiological jejunostomy approach may also be a worthwhile alternative, obviating the need for the patient to undergo endoscopy .…”

“…Access to clinic or phone consultations with healthcare professionals provides reassurance to both patients and carers and may also reduce the risk of discontinuation. Other important support measures to maintain continuation include follow‐up rating scales to provide objectivity in treatment decisions, regular pump checks, written checklists and links to support groups …”