title: The use of enteral access for continuous delivery of levodopa-carbidopa in patients with advanced Parkinson's disease.
abstract: BACKGROUND
  Continuous delivery to the jejunum of levodopa-carbidopa is a promising therapy in patients with advanced Parkinson's disease, as it reduces motor fluctuation. Percutaneous endoscopic gastrostomy and jejunal tube (PEG-J) placement is a suitable option for this. However, studies focused in PEG-J management are lacking.
  
  
  OBJECTIVE
  We report our experience regarding this technique, including technical success, adverse events and outcomes, in patients with advanced Parkinson's disease.
  
  
  METHODS
  Twenty-seven advanced Parkinson's disease patients (17 men, median age: 64 years, median disease duration: 11 years) were included in a retrospective study from June 2007 to April 2015. The median follow-up period was 48 months (1-96).
  
  
  RESULTS
  No adverse events were noted during and after nasojejunal tube insertion (to assess treatment efficacy). After a good therapeutic response, a PEG-J was placed successfully in all patients. The PEG tube was inserted according to Ponsky's method. The jejunal extension was inserted during the same procedure in all patients. Twelve patients (44%) experienced severe adverse events related to the PEG-J insertion, which occurred after a median follow-up of 15.5 months. Endoscopy was the main treatment modality. Patients who experienced severe adverse events had a higher comorbidity score (p= 0.011) but were not older (p= 0.941) than patients who did not.
  
  
  CONCLUSIONS
  While all patients responded well to levodopa-carbidopa regarding neurological outcomes, gastro-intestinal severe adverse events were frequent and related to comorbidities. Endoscopic treatment is the cornerstone for management of PEG-J related events. In conclusion, clinicians and endoscopists, as well as patients, should be fully informed of procedure-related adverse events and patients should be followed in centres experienced in their management.
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Julian
authors.initials: J
authors.lastname: Cheron
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Deviere
authors.affiliation: Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Frederic
authors.initials: F
authors.lastname: Supiot
authors.affiliation: Nutrition Team, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Asuncion
authors.initials: A
authors.lastname: Ballarin
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Eisendrath
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Toussaint
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Huberty
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Carmen
authors.initials: C
authors.lastname: Musala
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Blero
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lemmers
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Nutrition Team, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: André
authors.initials: A
authors.lastname: Van Gossum
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Nutrition Team, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Marianna
authors.initials: M
authors.lastname: Arvanitakis
keywords: PEG; PEG-J; Parkinson’s disease; adverse events; duodopa; levodopa; percutaneous endoscopic gastrostomy and jejunal tube