title: 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: OBJECTIVE
  Continuous infusion of levodopa carbidopa intestinal gel (LCIG) is associated with a significant improvement in the symptoms and quality of life of selected patients with advanced Parkinson's disease. Percutaneous endoscopic gastrostomy with jejunal extension (PEG/J) was first described in 1998 and has become the most common and standard technique for fixing the tubing in place for LCIG infusion.
  
  
  METHODS
  A workshop was held in Stockholm, Sweden, to discuss the PEG/J placement for the delivery of LCIG in Parkinson's disease patients with the primary goal of providing guidance on best practice for the Nordic countries.
  
  
  RESULTS
  Suggested procedures for preparation of patients for PEG/J placement, aftercare, troubleshooting and redo-procedures for use in the Nordic region are described and discussed.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical Gastroenterology and Hepatology, Medical Department, Koege Hospital , Koege , Denmark.
authors.forename: Sanne
authors.initials: S
authors.lastname: Dam-Larsen
authors.forename: Bahman
authors.initials: B
authors.lastname: Darkahi
authors.forename: Arne
authors.initials: A
authors.lastname: Glad
authors.forename: Dagfinn
authors.initials: D
authors.lastname: Gleditsch
authors.forename: Lena
authors.initials: L
authors.lastname: Gustavsson
authors.forename: Jorma
authors.initials: J
authors.lastname: Halttunen
authors.forename: Karl Erik
authors.initials: KE
authors.lastname: Johansson
authors.forename: Andreas
authors.initials: A
authors.lastname: Pischel
authors.forename: Ola
authors.initials: O
authors.lastname: Reiertsen
authors.forename: Björn
authors.initials: B
authors.lastname: Törnqvist
authors.forename: Hubert
authors.initials: H
authors.lastname: Zebski
mesh_terms: D000978:Antiparkinson Agents / Q000008:administration & dosage*; D002230:Carbidopa / Q000008:administration & dosage*; D005774:Gastrostomy / Q000379:methods*; D005782:Gels; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage*; D010300:Parkinson Disease / Q000601:surgery* / Q000628:therapy; D018579:Patient Selection; D011183:Postoperative Complications; D011788:Quality of Life; D012537:Scandinavian and Nordic Countries
chemical_list: D000978:Antiparkinson Agents; D005782:Gels; D007980:Levodopa; D002230:Carbidopa
keywords: PEG placement; Parkinson’s disease; levodopa carbidopa intestinal gel; percutaneous endoscopic gastrostomy jejunal extension