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Background
Reducing percutaneous endoscopic gastrostomies with jejunal extension tubes (PEG-J) related complications is vital to the long-term preservation of duodenal levodopa infusion (DLI) in advanced Parkinson’s disease (APD). Here, we provide data on the frequency of complications for both the standard “pull” and the non-endoscopic, radiologic...
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Context 1
... PEG-J duration was of 7,6 and 5,6 months for the "pull" and "push" methods, respectively. A comparison of clinical features for "pull" and "push" technique is reported in Table 2: a t-test (FDR corrected) showed no significant differences for age, disease duration, follow-up duration, UPDRS III score, mH&Y score and PEG-J duration. The paired t-test to compare scheduled replacements and unexpected replacements groups was significant (p < 0.05), however, after the FDR correction for variability did not showed this result due to the low number of subjects for each group (Table 2). ...Context 2
... comparison of clinical features for "pull" and "push" technique is reported in Table 2: a t-test (FDR corrected) showed no significant differences for age, disease duration, follow-up duration, UPDRS III score, mH&Y score and PEG-J duration. The paired t-test to compare scheduled replacements and unexpected replacements groups was significant (p < 0.05), however, after the FDR correction for variability did not showed this result due to the low number of subjects for each group (Table 2). ...Citations
... Compared to previous reports that have individually assessed JET-PEG [19][20][21][22] or N-PEG [23,24] cohorts, we have also observed similar rates of late complications including stoma granulomas, infection, leaking, and painful purulent secretion. In our study, the incidence of technical complications related to the PEG and jejunal tube was high in the JET-PEG group including J-tube malfunction (caused by accidental cutting or extraction), obstruction and leaking of the tube, and tube kinging or dislocation. ...
... JET-PEG in individuals with PD increases their gastrointestinal morbidity, mainly with stoma pathologies. Our data show similar results as previously reported in JET-PEG individuals [19,20]. ...
Citation: Gombošová, L.; Deptová, J.; Jochmanová, I.; Svoreňová, T.; Veseliny, E.; Zakuciová, M.; Haň, V.; Lacková, A.; Kulcsárová, K.; Ostrožovičová, M.; et al. Endoscopic Abstract: Background: To date, no studies comparing complication rates between patients with nutritional percutaneous endoscopic gastrostomy (N-PEG) and Parkinson's disease (PD) patients with percutaneous endoscopic gastro-jejunostomy (JET-PEG) for treatment administration have been published. Our study aimed to compare complication rates and the number of re-endoscopies between N-PEG and JET-PEG patients. Methods: Individuals requiring N-PEG or JET-PEG insertion between 2014 and 2021 were included in this single-center retrospective observational study. Complications were divided into time-related medical and technical complications. Reasons for post-insertion re-endoscopies and their number were also analyzed. Results: Eighty-seven subjects, 47 (54.02%) in JET-PEG group and 40 (45.98%) in the N-PEG group, were included. Early and technical complications were more frequent in JET-PEG vs. N-PEG subjects (70% vs. 10% [p < 0.001], and 54.5% vs. 5.1% [p < 0.001], respectively). The presence of psychiatric disease was associated with a higher number of early complications (p < 0.002). All three types of complications were significantly more frequent in subjects where a healthcare professional did not handle PEG (p < 0.001). Subjects with JET-PEG required a higher number of re-endoscopies compared to the N-PEG group (57.1% vs. 35%, p = 0.05). Conclusions: Complications are significantly more common in individuals with JET-PEG than those with N-PEG, which can be attributed to higher mobility in PD patients.
... Tube revision is required for various reasons during the follow-up of PEG-J patients. Viljaharju et al. 10 and Simoni et al. 17 found the need for at least one tube replacement in 57% and 56.6% of patients, respectively. In this study, at least one tube replacement was required at a rate of 61.8%, slightly more than in these studies. ...
... Viljaharju et al. reported that over 90 percent of tube replacements were due to tuberelated AE. Simoni et al. 17 also reported that 82% of the reasons for replacement were tube-related problems and the most common reason for tube replacement was inner tube dislocation. Udd et al., 9 on the other hand, showed that the causes of tube replacement were predominantly due to tube-related AE and reported that 38% were due to accidental removal of the inner tube and 29% to the occlusion of the inner tube. ...
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.
... Patients were mildly premedicated with benzodiazepine (midazolam 3 mg i.v.), and intravenous antibiotic prophylaxis (cefazolin 2 g i.v) was applied one hour before the procedure. The procedure was performed in local anesthesia by the standard endoscopic "pull" approach (procedure is described in detail in reference [19]). Latex or polyurethane (since 2015) PEG-J system with internal fixation plate (AbbVie Inc.) was used. ...
Objectives:
Levodopa/carbidopa intrajejunal gel (LCIG) is an effective therapeutic strategy to overcome levodopa-induced motor complications in advanced Parkinson's disease (PD). However, it requires invasive percutaneous endoscopic gastrojejunostomy (PEG-J) and may be associated with serious adverse effects (AE). In this study, we aimed to evaluate long-term AEs related to LCIG treatment in a large homogenous cohort of advanced PD patients.
Methods:
One hundred three consecutive PD patients were regularly monitored for LCIG-related, PEG-J-related, and device-related AEs up to 14 years. Incidence of AEs was studied in time applying a time-to-event analysis and Cox proportional hazard model with age, disease duration, gender, and recurrent AE as covariates. Health-related quality of life (HRQoL) was estimated at each visit and compared to HRQoL before the LCIG treatment.
Results:
Among 296 AEs noted, 48.8% were LCIG-related, 32.4% PEG-J-related, and 19.6% device-related. While most of the studied AEs steadily accumulated throughout the follow-up period, 24.3% of the patients (95% CI 10.1%-36.3%) experienced PEG-J-related AE already within the first days after the PEG-J insertion. Cox model revealed that older patients had higher probability of psychosis, PEG-J- and device-related AEs (p < .05, p < .05, and p = .02) and suggested increased recurrence risk in those with early PEG-J and device-related AEs. Despite relatively high incidence of AEs, HRQoL significantly increased in the follow-up period (p < .0001).
Conclusion:
AEs related to LCIG treatment are common. Therefore, careful patient selection and monitoring throughout the treatment is recommended, especially in those with early side effects. Nevertheless, LCIG significantly improves HRQoL in advanced PD patients on a long term.
Patients with Parkinson’s disease (PD), often elderly with various comorbidities, may require a continuous intestinal infusion of carbidopa/levodopa gel by the placement of a percutaneous endoscopic gastrostomy (PEG) with a jejunal tube (PEG-J) to improve their motor outcome and quality of life. However, it is unclear what is the best procedural sedation protocol for PEG-J procedures. Fifty patients with PD and indication for PEG-J procedure (implantation, replacement, removal) underwent, from 2017 to 2022, a sedation protocol characterized by premedication with atropine (0.01 mg/Kg i.v. ), midazolam (0.015–0.03 mg/Kg i.v. ) and induction with bolus propofol (0.5–1 mg/Kg i.v. ) as well as, finally, sedation with continuous infusion propofol (2–5 mg/Kg/h i.v. ) by Target Controlled Infusion (TCI) technique. Ninety-eight per cent of patients experienced no intraprocedural or peri-procedural adverse events. All the procedures were technically successful. A good discharge time was recorded. The vital parameters recorded during the procedure did not vary significantly. A PEG-J procedure conducted within 30 min showed a significant advantage over end-tidal carbon dioxide (EtCO 2 ). Indeed, the latter showed some predictive behavior (OR: 1.318, 95% CI 1.075–1.615, p = 0.008). In the real world, this sedation protocol showed a good safety and effectiveness profile, even with reduced doses of midazolam and a TCI propofol technique in moderate sedation.
For patients requiring long-term (>4 weeks) jejunal nutrition, jejunal medication delivery, or decompression, a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) or a direct percutaneous endoscopic jejunostomy (DPEJ) may be indicated. PEG-J is the preferred option if a PEG tube is already in place or if simultaneous gastric decompression and jejunal nutrition are needed. DPEJ is recommended for patients with altered anatomy due to foregut surgery, high risk of jejunal extension migration, and whenever PEG-J fails. Successful placement rates are lower for DPEJ but recent publications have reported improvements, partly due to the use of balloon-assisted enteroscopy. Both techniques are contraindicated in cases of active peritonitis, uncorrectable coagulopathy, and ongoing bowel ischaemia, and relative contraindications include, among other, peptic ulcer disease and haemodynamic or respiratory instability. In this narrative review, we present the most recent evidence on indications, contraindications, technical considerations, adverse events, and outcomes of PEG-J and DPEJ.
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.
