Percutaneous Endoscopic Gastrostomy with Jejunal Extension Tube for the Delivery of Levodopa Carbidopa Intestinal Gel: Clinical Practice Guidelines of the Romanian Society of Digestive Endoscopy

Abstract

Percutaneous endoscopic gastrostomy with jejunal extension (PEG/J) was first described in 1998 and has become the standard technique for fixing the tube in place for levodopa carbidopa intestinal gel (LCIG) infusion. The Romanian Society of Digestive Endoscopy (RSDE) decided to create a consensus paper to meet the needs in medical training and practice. After reviewing the available published data and existing recommendations, a consensus process was carried out involving the leaders of opinion in this field. The resulting text and recommendations were approved, after reaching expert consensus, and reflects the views of the RSDE for the best practice of PEG/J tube placement. The pull through method (“pull technique”) is the prevailing PEG-tube placement procedure in Romania. The procedure can be performed with intravenous sedation combined with local anesthesia. Although minor complications are common, serious complications are infrequent, and the tube insertion procedures have a good safety record. Redo procedures are sometimes necessary and clinicians should be aware of these situations.

Optimised endoscopic access for intrajejunal levodopa application in idiopathic Parkinson's syndrome

“…For the intrajejunal levodopa application discussed here-which is considered one of the three standard therapies for advanced Parkinson's syndrome-temporary (e.g. for testing levodopa administration), a nasoenteric tube can be inserted, but usually a PEG with an internal catheter, a so-called JET-PEG, is inserted for permanent therapy (Dam-Larsen et al 2015;Lex et al 2018;Gheorghe et al 2019).…”