Year 2019 / Volume 111 / Number 11
Original
Endoscopic management of duodenal levodopa-carbidopa therapy of advanced Parkinson’s disease

828-832

DOI: 10.17235/reed.2019.6311/2019

Carmen Garrido Durán, Sam Khorrami Minaei, Pau Sendra Rumbeu, Joaquín Fernández García, Marcelo García Hernández, Inés Legarda Ramírez,

Abstract
Background: treatment of intraduodenal levodopa using percutaneous endoscopic gastrostomy is an alternative therapy in patients with advanced Parkinson’s disease. There are few studies that have evaluated the endoscopic aspects of this technique. Objectives: to describe our experience and adverse events regarding this technique in advanced Parkinson’s disease. Method: a retrospective study was performed from January 2007 to January 2019 in a tertiary healthcare center. Results: thirty-seven patients aged 65.1 ± 10.3 years were included in the study, 21 were male and the disease duration was ten years (1-26). The median follow-up was 16 months (1-144). The device was successfully placed in all cases. The persistence rate with the PEG-D at the end of follow-up was 62.2%. The system was removed in 14 patients, seven due to neurological impairment, four because of the decision of the patient and three due to related events. Fifty-nine adverse events occurred in 23 patients (62.2%, 0.63 per patient-year), four of which were severe (8.1%, 0.05 per patient-year). Minor adverse events included 14 (37.8%) related to the stoma, six (16.2%) to the gastric tube and 15 (40.5%) to the duodenal tube. Forty-four system replacements were performed in 20 patients (54.1%, 0.52 per patient-year). Male sex, age over 70 and a higher comorbidity index were associated with a greater likelihood of persistence of the system (OR: 0.14, 95% CI: 0.03-0.62; OR: 0.52, 95% CI: 0.32-0.86; OR: 0.16, 95% CI: 0.03-0.99, respectively). No predictors of adverse events associated with PEG-D were identified. Conclusions: percutaneous endoscopic gastrostomy for the continuous delivery of duodenal levodopa is a highly effective technique. Adverse events are common, although most are resolved by endoscopy.
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References
1.Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987; 40(5): 373-83.
2.Olanow, C. W., Kieburtz, K., Odin, et al. Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel for patients with advanced Parkinson’s disease: A randomised, controlled, double- blind, double-dummy study. Lancet Neurology 2014; 13(2):141-9.
3.Nyholm D. Duodopa Treatment for advanced Parkinson disease: A review of efficacy and safety. Parkinsonism Relat Disord 2012;(18): 916-29.
4.Buongiorno M, Antonelli F, Cámara A, et al. Long-term response to continous duodenal infusion of levodopa/carbidopa gel in patients with advanced Parkinson disease: The Barcelona registry. Parkinsonism Relat Disord 2015;21(8):871-6.
5.Bredberg E, Nilsson D, Johansson K, et al. Intraduodenal infusion of a water- based levodopa dispersion for optimisation of the therapeutic effect in severe Parkinson’s disease. Eur J Clin Pharmacol. 1993;45(2):117-22.
6.Yañez Baña RM. Infusión de Duodopa en la enfermedad de Parkinson. Rev Esp de Trastornos del Movimiento 2007;7:21-5.
7.Santos-García D M. Macías, M. Llaneza, et al.Experiencia con la infusión continua con levodopa intraduodenal (Duodopa) en pacientes con enfermedad de Parkinson avanzada en un hospital de segundo nivel asistencial. Neurología 2010;25(9):536-43.
8.Fernández HH, Vanagunas A, Odin P, et al. Levodopa-carbidopa intestinal gel in advanced Parkinson’s disease open-label study: interim results. Parkinsonism Relat Disord 2013;19(3): 339-45.
9.Zibetti M, Merola A, Ricchi V, et al. Long-term duodenal levodopa infusion in Parkinson’s disease: a 3-year motor and cognitive follow-up study. J Neurol 2013; 260(1):105-14.
10.Negreaunu L, Popescu BO, Babiuc RD, et al. Duodopa infusion treatment: a point of view from the gastroenterologist. J Gastrointest Liver Dis 2011;20(3):325-7.
11.Dam-Larsen S, Darkahi B, Glad A, et al. 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. Scand J Gastroenterol 2015;50(12): 1500-7.
12.Santos-García D, De Deus T, López-Pazos E, et al. Manejo de las complicaciones relacionadas con la infusión intraduodenal de levodopa/carbidopa en pacientes con enfermedad de Parkinson. Rev Neurol 2014; 58: 505-15.
13.Klosterman F, Jugel C, Bömelburg M, et al. Severe gastrointestinal complications in patients with levodopa/carbidopa intestinal gel infusion. Movement Disorders 2012; 27(13):1704-6.
14.Cheron J, Deviere J, Supiot F, et al. The use of enteral access for continuous delivery of levodopa-carbidopa in patients with advanced Parkinson’s disease. United European Gastroenterology Journal 2017; 5(1): 60-8.
15.Udd M, Lyytinen J, Eerola-Rautio J, et al. Problems related to levodopa-carbidopa intestinal gel treatment in advanced Parkinson´s disease. Brain Behav 2017;7(7):e00737.
16.Devos D, French DUODOPA Study Group (2009). Patient profile, indications, efficacy and safety of duodenal levodopa infusion in advanced Parkinson’s disease. Movement Disorders 2009; 24(7): 993-1000.
17.Jafri NS, Mahidà SS, Minor KS, et al. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther 2007; 25(6): 647-56.
18.Magaz Martínez M, Martinez Porras JL, López Gómez M, et al. Endoscopic alternative to buried bumper syndrome secondary to Duodopa® pump treatment. Gastroenterol Hepatol 2017; 40(5):360-2.
19.El AZ, Arvanitakis M, Ballarin A, et al. Buried bumper síndrome: Low incidence and safe endoscopic management. Acta Gastroenterol Belg 2011;74(2):312-6.
20.Güvenç BH, Rasa K, Güvenç S. The presence of percutaneous endoscopic gastrostomy (PEG)-related postprocedural pneumoperitoneum. Endoscopy 2009;41(Suppl 2): E269-70.
21.Murphy CJ, Adler DG, Cox K, et al. Insufflation with carbon dioxide reduces pneumoperitoneum after percutaneous endoscopic gastrostomy (PEG):a randomized controlled trial. Endosc Int Open 2016;4(3):E292-5.
22.Nishiwaki S, Araki H, Hayashi M et al. Inhibitory effects of carbon dioxide insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy. World J Gastroenterol 2012;18(27): 3565-70.
23.del-Hoyo-Francisco J, Bustamante-Balen M, Martínez-Torres I, et al. Knotting of Duodopa(R) duodenal infusion system. Rev Esp Enferm Digest 2015; 107(5): 323-4.
24.Magaz Martínez M, Martínez Porras JL, Oliva B, et al. Yeyunitis secundaria a sonda de Duodopa, una complicación diferente. Rev Esp Enferm Digest 2016; 108(12): 815-6.
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Garrido Durán C, Khorrami Minaei S, Sendra Rumbeu P, Fernández García J, García Hernández M, Legarda Ramírez I, et all. Endoscopic management of duodenal levodopa-carbidopa therapy of advanced Parkinson’s disease. 6311/2019


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Publication history

Received: 31/03/2019

Accepted: 01/05/2019

Online First: 30/09/2019

Published: 07/11/2019

Article revision time: 22 days

Article Online First time: 183 days

Article editing time: 221 days


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