The use of enteral access for continuous delivery of levodopa‐carbidopa in patients with advanced Parkinson’s disease

Cheron, Julian; Devière, Jacques; Supiot, Frédéric; Ballarin, Asuncion; Eisendrath, Pierre; Toussaint, E; Huberty, Vincent; Musala, Carmen; Bléro, Daniel; Lemmers, Arnaud; Gossum, A. Van; Arvanitakis, Marianna

doi:10.1177/2050640616650804

Cited by 13 publications

(3 citation statements)

References 26 publications

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“…4,7-14 Viljaharju et al 10 reported that a single case of peritonitis died among 103 patients. Cheron et al 14 reported that one closed duodenal perforation and one intra-abdominal infectious collection were cured with conservative treatment. Ebstein et al 13 reported that five of eight peritonitis cases treated conservatively, three of them surgically, all patients were successfully treated.…”

Section: Discussionmentioning

confidence: 99%

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

TENLİK,

ÖZTÜRK,

ARI

et al. 2023

J Med Palliat Care / JOMPAC / jompac

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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.

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Section: Discussionmentioning

confidence: 99%

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

TENLİK,

ÖZTÜRK,

ARI

et al. 2023

J Med Palliat Care / JOMPAC / jompac

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“…Thus, BBS might be unnoticed until severe symptoms occur or are incidentally identified. It was reported that the frequency of BBS in PEG-J for PD on LCIG treatment was 7.4–17.1%, which was much higher than that of BBS in PEG in general [ 6 , 7 ]. The median interval time between placement of PEG-J and occurrence of BBS was reported to be 25.5 months [ 6 ].Once BBS in PEG-J occurs, simultaneous removal and replacement are ideal to avoid LCIG treatment cessation, but detailed information for its surgical procedure is yet to be introduced.…”

Section: Introductionmentioning

confidence: 99%

Buried bumper syndrome in percutaneous endoscopic gastrostomy with a jejunal extension tube in patients undergoing levodopa–carbidopa intestinal gel treatment

Nakagawa,

Inoue,

Takise

et al. 2023

surg case rep

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Background Levodopa–carbidopa intestinal gel (LCIG) treatment is an effective Parkinson’s disease (PD) treatment that requires percutaneous endoscopic gastrostomy with a jejunal extension tube (PEG-J). Buried bumper syndrome (BBS) is an uncommon but significant complication of PEG-J for LCIG. Case presentation A 71-year-old man had been undergoing LCIG therapy for PD since a PEG-J was implemented at our department two years previously. He presented with appetite loss. Computed tomography showed that the gastrostomy bumper was buried in the gastric wall. The patient was surgically treated with the simultaneous removal and replacement of PEG-J. Postoperative gastrocutaneous fistula occurred, which was conservatively treated. Conclusions Notably, patients and medical staff should be aware that patients with PD on LCIG treatment have a high risk of BBS in PEG-J and that there might be some patients with latent BBS. When simultaneous removal and replacement surgery is performed, establishing a new route at the stomach and abdominal wall is recommended.

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Parkinson's disease (PD) is a neurodegenerative disorder characterized by tremor, bradykinesia, rigidity, and postural instability. Degeneration of dopamine-producing neurons results in PD impairments to motor function (Cheron et al, 2017). Levodopa remains the gold standard treatment for PD symptom management; however, the long-term use of oral levodopa is associated with the development of significant complications including motor and nonmotor fluctuations and dyskinesias.

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mentioning

confidence: 99%

Enhancing Self-Management of Percutaneous Endoscopic Gastrostomy Tubes Through the Implementation of a Standardized Education and Assessment Pathway

Reardon

Truax

Naranian

et al. 2023

Gastroenterology Nursing

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Intraduodenal infusion of levodopa–carbidopa intestinal gel by percutaneous endoscopic gastrostomy tube with jejunal extension is a treatment option to reduce motor and nonmotor complications in patients with advanced Parkinson's disease when oral therapy no longer provides sufficient benefit. Medication management is of central focus; however, there was no standardized patient education on stoma-site care and tube maintenance, leading to the development of stoma-site complications. As a quality improvement (QI) initiative, a standardized education and assessment pathway was developed and implemented in an urban academic outpatient clinic to enhance patient self-management and reduce stoma-site complications. A retrospective chart review was conducted to establish baseline incidence of cutaneous stoma-site complications. QI interventions were implemented using a rapid-cycle improvement model. Routine stoma assessments by a nurse who specializes in wound, ostomy, and continence care were implemented at set points, and patient education on PEG tube care and maintenance was reinforced at each session. Results demonstrated a significant reduction in moderate-to-severe tube and stoma-site–related complication. Implementation of a similar standardized education and assessment pathway in patients with percutaneous endoscopic gastrostomy tubes may lead to a decrease in stoma-site–related complications and overall better patient self-management.

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The use of enteral access for continuous delivery of levodopa‐carbidopa in patients with advanced Parkinson’s disease

Cited by 13 publications

References 26 publications

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

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

Buried bumper syndrome in percutaneous endoscopic gastrostomy with a jejunal extension tube in patients undergoing levodopa–carbidopa intestinal gel treatment

Enhancing Self-Management of Percutaneous Endoscopic Gastrostomy Tubes Through the Implementation of a Standardized Education and Assessment Pathway

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