Complications of percutaneous endoscopic gastrostomy-jejunostomy for levodopa/carbidopa infusion in advanced Parkinson's disease

Abstract

Continuous infusions of levodopa directly into the duodenum-yeyunum is an effective therapy to reduce daily off time in an advanced stage of Parkinson's disease, but it is not without complications, particularly device related problems. We present our experience in three Spanish hospitals with these complications, including a severe case with migration, several decubitus ulcers, and one case of perforation of the bowel and finally death

Fistulization of J-PEG Jejunal Tube into the Colon in a Patient Treated with Duodopa® Infusion: A Case Report

“…The patient required intestinal resection and died from postoperative complications [7] . Olivares et al [8] reported the case of a patient with mechanical small bowel obstruction. The investigation revealed multiple ulcerations in the duodenum and jejunum and the fistulization of the tube through the jejunal wall into the mesenteric root.…”

“…Immediate surgery was required which showed multiple areas of intestinal perforation. The patient died after 2 days [8] . The same authors described a case of a large antro-duodenal ulcer due to the pressure of the jejunal tube.…”

“…After an endoscopic removal attempt, severe hemorrhage and hemodynamic instability were noted. The pigtail ending of the tube was clogged with a bezoar [8] .…”

Duodenal Decubitus Ulcer Caused by Percutaneous Endoscopic Transgastric Jejunostomy Tube

“…To the best of our knowledge, there are few reports of decubitus ulcer caused by PEG-J tube. [13][14][15] Nevertheless, several cases of small bowel perforation caused by jejunal extension tube have been published. [16][17][18] We assume that decubitus ulcer is seldom recognized early and is diagnosed when it causes perforation, because most of those who maintain enteral feeding via PEG-J are not able to complain of ulcer symptoms.…”

Phytobezoar Associated with Levodopa-carbidopa Intestinal Gel Infusion in Patients with Parkinson's Disease: A Case Report and Literature Review

“…The risk factors for bezoar formation include a history of gastric surgery, ingestion of fiber-rich foods, and suffering from systemic diseases, such as hypothyroidism and diabetes mellitus (4). Phytobezoar associated with LCIG is a rare device-related complication that forms compressive erosion, ulcerative lesions, and fistulas due to tube extension in the gastrointestinal tract and can be fatal at times (5)(6)(7)(8)(9)(10)(11)(12)(13).…”