Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous

Fahd Baig; Mihaela Boca; Lucy Mooney; Lucy Cheminais; Marianna Selikhova; Michal Rolinski; Konrad Szewczyk-Krolikowski; Neil Collin; Alan Whone

doi:10.1016/j.parkreldis.2021.06.022

Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous

Fahd Baig, Mihaela Boca, Lucy Mooney, Lucy Cheminais, Marianna Selikhova, Michal Rolinski, Konrad Szewczyk-Krolikowski, Neil Collin, Alan Whone

Research output: Contribution to journal › Article (Academic Journal) › peer-review

1 Citation (Scopus)

Abstract

BACKGROUND: Procedural aspects and complications of gastrojejunostomy insertion are important considerations in the use of levodopa-carbidopa intestinal gel therapy (LCIG) and may limit uptake. We describe our experience of using per-oral image guided gastrojejunostomy (PIG-J) which avoids the need for endoscopy and routine sedation in percutaneous endoscopic gastrojejunostomy (PEG-J) and allows more secure tube placement than radiologically inserted gastrojejunostomy techniques.

METHODS: We describe a case series of 32 patients undergoing PIG-J insertion for LCIG therapy in a single centre. Under local anaesthetic, a fluoroscopy-guided gastric puncture allows access for the guidewire which is then used to pull through the gastrostomy tube allowing for secure fixation, followed by placement of the gastrojejunal extension.

RESULTS: Between December 2015 to April 2020, 32/34 patients referred for PIG-J underwent this procedure successfully, 2 cases unsuccessful due to technical considerations. One patient developed delirium following successful implantation. Ten patients (31%) required a replacement tube due to blockage or displacement within the first 12 months of placement, including 2 patients who needed more than one replacement. Minor complications occurred in 10 other patients (31%), including infection (9 patients); a small haematoma not requiring intervention who later developed an infection (1 patient); and peri-stomal acid leakage (1 patient).

CONCLUSION: In summary, PIG-J insertion is safe with a similar complication rate to traditional PEG-J, well tolerated and effective for use in LCIG administration. This may widen access to LCIG for PD patients who may not be suitable or unable to tolerate PEG-J.

Original language	English
Pages (from-to)	34-37
Number of pages	4
Journal	Parkinsonism and Related Disorders
Volume	89
Early online date	29 Jun 2021
DOIs	https://doi.org/10.1016/j.parkreldis.2021.06.022
Publication status	Published - Aug 2021

Bibliographical note

Funding Information:
We would like to acknowledge the efforts of all the staff who contribute to the advanced treatment service at North Bristol NHS Trust, and our patients who are at the centre of all this work.

Publisher Copyright:
© 2021 Elsevier Ltd

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Baig, F., Boca, M., Mooney, L., Cheminais, L., Selikhova, M., Rolinski, M., Szewczyk-Krolikowski, K., Collin, N., & Whone, A. (2021). Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous. Parkinsonism and Related Disorders, 89, 34-37. https://doi.org/10.1016/j.parkreldis.2021.06.022

@article{32b900a599e942afb7fb836dd907e507,

title = "Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous",

abstract = "BACKGROUND: Procedural aspects and complications of gastrojejunostomy insertion are important considerations in the use of levodopa-carbidopa intestinal gel therapy (LCIG) and may limit uptake. We describe our experience of using per-oral image guided gastrojejunostomy (PIG-J) which avoids the need for endoscopy and routine sedation in percutaneous endoscopic gastrojejunostomy (PEG-J) and allows more secure tube placement than radiologically inserted gastrojejunostomy techniques.METHODS: We describe a case series of 32 patients undergoing PIG-J insertion for LCIG therapy in a single centre. Under local anaesthetic, a fluoroscopy-guided gastric puncture allows access for the guidewire which is then used to pull through the gastrostomy tube allowing for secure fixation, followed by placement of the gastrojejunal extension.RESULTS: Between December 2015 to April 2020, 32/34 patients referred for PIG-J underwent this procedure successfully, 2 cases unsuccessful due to technical considerations. One patient developed delirium following successful implantation. Ten patients (31%) required a replacement tube due to blockage or displacement within the first 12 months of placement, including 2 patients who needed more than one replacement. Minor complications occurred in 10 other patients (31%), including infection (9 patients); a small haematoma not requiring intervention who later developed an infection (1 patient); and peri-stomal acid leakage (1 patient).CONCLUSION: In summary, PIG-J insertion is safe with a similar complication rate to traditional PEG-J, well tolerated and effective for use in LCIG administration. This may widen access to LCIG for PD patients who may not be suitable or unable to tolerate PEG-J.",

author = "Fahd Baig and Mihaela Boca and Lucy Mooney and Lucy Cheminais and Marianna Selikhova and Michal Rolinski and Konrad Szewczyk-Krolikowski and Neil Collin and Alan Whone",

note = "Funding Information: We would like to acknowledge the efforts of all the staff who contribute to the advanced treatment service at North Bristol NHS Trust, and our patients who are at the centre of all this work. Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd",

year = "2021",

month = aug,

doi = "10.1016/j.parkreldis.2021.06.022",

language = "English",

volume = "89",

pages = "34--37",

journal = "Parkinsonism and Related Disorders",

issn = "1353-8020",

publisher = "Elsevier Science",

}

Baig, F, Boca, M, Mooney, L, Cheminais, L, Selikhova, M, Rolinski, M, Szewczyk-Krolikowski, K, Collin, N & Whone, A 2021, 'Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous', Parkinsonism and Related Disorders, vol. 89, pp. 34-37. https://doi.org/10.1016/j.parkreldis.2021.06.022

TY - JOUR

T1 - Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous

AU - Baig, Fahd

AU - Boca, Mihaela

AU - Mooney, Lucy

AU - Cheminais, Lucy

AU - Selikhova, Marianna

AU - Rolinski, Michal

AU - Szewczyk-Krolikowski, Konrad

AU - Collin, Neil

AU - Whone, Alan

N1 - Funding Information: We would like to acknowledge the efforts of all the staff who contribute to the advanced treatment service at North Bristol NHS Trust, and our patients who are at the centre of all this work. Publisher Copyright: © 2021 Elsevier Ltd

PY - 2021/8

Y1 - 2021/8

N2 - BACKGROUND: Procedural aspects and complications of gastrojejunostomy insertion are important considerations in the use of levodopa-carbidopa intestinal gel therapy (LCIG) and may limit uptake. We describe our experience of using per-oral image guided gastrojejunostomy (PIG-J) which avoids the need for endoscopy and routine sedation in percutaneous endoscopic gastrojejunostomy (PEG-J) and allows more secure tube placement than radiologically inserted gastrojejunostomy techniques.METHODS: We describe a case series of 32 patients undergoing PIG-J insertion for LCIG therapy in a single centre. Under local anaesthetic, a fluoroscopy-guided gastric puncture allows access for the guidewire which is then used to pull through the gastrostomy tube allowing for secure fixation, followed by placement of the gastrojejunal extension.RESULTS: Between December 2015 to April 2020, 32/34 patients referred for PIG-J underwent this procedure successfully, 2 cases unsuccessful due to technical considerations. One patient developed delirium following successful implantation. Ten patients (31%) required a replacement tube due to blockage or displacement within the first 12 months of placement, including 2 patients who needed more than one replacement. Minor complications occurred in 10 other patients (31%), including infection (9 patients); a small haematoma not requiring intervention who later developed an infection (1 patient); and peri-stomal acid leakage (1 patient).CONCLUSION: In summary, PIG-J insertion is safe with a similar complication rate to traditional PEG-J, well tolerated and effective for use in LCIG administration. This may widen access to LCIG for PD patients who may not be suitable or unable to tolerate PEG-J.

AB - BACKGROUND: Procedural aspects and complications of gastrojejunostomy insertion are important considerations in the use of levodopa-carbidopa intestinal gel therapy (LCIG) and may limit uptake. We describe our experience of using per-oral image guided gastrojejunostomy (PIG-J) which avoids the need for endoscopy and routine sedation in percutaneous endoscopic gastrojejunostomy (PEG-J) and allows more secure tube placement than radiologically inserted gastrojejunostomy techniques.METHODS: We describe a case series of 32 patients undergoing PIG-J insertion for LCIG therapy in a single centre. Under local anaesthetic, a fluoroscopy-guided gastric puncture allows access for the guidewire which is then used to pull through the gastrostomy tube allowing for secure fixation, followed by placement of the gastrojejunal extension.RESULTS: Between December 2015 to April 2020, 32/34 patients referred for PIG-J underwent this procedure successfully, 2 cases unsuccessful due to technical considerations. One patient developed delirium following successful implantation. Ten patients (31%) required a replacement tube due to blockage or displacement within the first 12 months of placement, including 2 patients who needed more than one replacement. Minor complications occurred in 10 other patients (31%), including infection (9 patients); a small haematoma not requiring intervention who later developed an infection (1 patient); and peri-stomal acid leakage (1 patient).CONCLUSION: In summary, PIG-J insertion is safe with a similar complication rate to traditional PEG-J, well tolerated and effective for use in LCIG administration. This may widen access to LCIG for PD patients who may not be suitable or unable to tolerate PEG-J.

U2 - 10.1016/j.parkreldis.2021.06.022

DO - 10.1016/j.parkreldis.2021.06.022

M3 - Article (Academic Journal)

C2 - 34218045

VL - 89

SP - 34

EP - 37

JO - Parkinsonism and Related Disorders

JF - Parkinsonism and Related Disorders

SN - 1353-8020

ER -

Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous

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