Levodopa-carbidopa intestinal gel therapy in Parkinson’s disease: Procedure complications

Abstract

Objectives. Continuous delivery of levodopa-carbidopa intestinal gel (LCIG) represents a gold standard option for the treatment of advanced PD and the benefits of intestinal gel delivery are significative superior from those obtained with available medical therapies. We aimed to investigate the percutaneous endoscopic transgastric jejunostomy (PEG-J) use and the occurrence of procedural complications in a group of patients diagnosed with PD Hoehn and Jahr 3 and 4 stages, receiving LCIG therapy. Materials and methods. We performed an observational retrospective cohort study on 24 PD patients recruited from a single regional tertiary center in Cluj-Napoca, Romania, between 2009 and 2019. We included PD patients with Hoehn and Jahr 3 and 4 stages under LCIG therapy. Results. PEG-J replacement was found in 54.2% of the patients. Erythema and inflammation at the level of stoma (37.5%) and allergic reactions (20.8%) were the most common complications. The most frequent reason for PEG-J replacement was tube dislocation (20.8%), and rarely the plied tube, the excess of adipose tissue, or bezoar (4.3% each). A third of the patients received PEG-J therapy during the night, after a median time of three years, after PEG-J initiation. A quarter of all the subjects had their Levodopa-Carbidopa therapy interrupted. The median time until interruption was one year. The reasons for the interruption were patient, or patient’s relative refuses, for a sixth of the cases, or gastric polyps, in very few cases. Conclusions. The most frequent complication of LCIG delivered by PEG-J was erythema and inflammation at the level of stoma. However LCIG therapy discontinuation was in particular due to the decision of the patient or relatives.

Keywords

• parkinson’s disease
• pd
• gastroenterological complications
• levodopa-carbidopa intestinal gel (lcig)