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Ueno T, Hanabata N, Katagai A, Okudera R, Arai A, Tomiyama M. Phytobezoar Associated with Levodopa-carbidopa Intestinal Gel Infusion in Patients with Parkinson's Disease: A Case Report and Literature Review. Intern Med 2021; 60:3317-3320. [PMID: 33867393 PMCID: PMC8580754 DOI: 10.2169/internalmedicine.7210-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel (LCIG) is an established device-aided therapy for advanced Parkinson's disease (PD). Phytobezoar associated with LCIG is a rare device-related complication and presents with exacerbations of gastrointestinal and PD symptoms. We herein report the case of a phytobezoar that was formed at a knot on the pigtail-shaped J-tube and developed only in association with postprandial abdominal pain, similar to a feeling of a tube being pulled in without an exacerbation of PD symptoms. Such abdominal pain may be a warning sign of phytobezoar in LCIG-treated patients. Despite device-related complications, high-pressure alarms are not always present, and PD symptoms are not always exacerbated.
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Affiliation(s)
- Tatsuya Ueno
- Department of Neurology, Aomori Prefectural Central Hospital, Japan
| | - Norihiro Hanabata
- Department of Gastroenterology, Aomori Prefectural Central Hospital, Japan
| | - Atsuko Katagai
- Department of Neurology, Aomori Prefectural Central Hospital, Japan
| | - Rena Okudera
- Department of Neurology, Aomori Prefectural Central Hospital, Japan
- Division of Neurology, Department of Internal Medicine, National Defense Medical College, Japan
| | - Akira Arai
- Department of Neurology, Aomori Prefectural Central Hospital, Japan
| | - Masahiko Tomiyama
- Department of Neurology, Hirosaki University Graduate School of Medicine, Japan
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Moralejo Lozano Ó, Barrajón Masa AJ, Colmenares Bulgheroni M. Intestinal burying of the jejunal-tube of a PEG-J levodopa-carbidopa release system for Parkinson's disease. Successful endoscopic management. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:226-227. [PMID: 33207895 DOI: 10.17235/reed.2020.7180/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Levodopa-carbidopa intestinal gel (LCIG) continuous infusion into the jejunum through a percutaneous endoscopic gastrostomy with a jejunal extension (PEG-J) is an alternative therapy for Parkinson's disease (PD) patients, with a very poor control of their symptoms on regular oral medications (Hoehn-Yahr stage IV). Around 62.2 % of patients present procedure and device-related adverse effects (AE), with an 8.2 % rate of mayor complications.
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Shimamura M, Shinzaki S, Ikenaka K, Konaka K, Hirozawa D, Ishikura T, Hideshima M, Nakano T, Kitano T, Takehara T, Mochizuki H. [Analysis of PEG-J associated complications in 14 adult patients treated with levodopa-carbidopa intestinal gel]. Rinsho Shinkeigaku 2019; 59:153-156. [PMID: 30814443 DOI: 10.5692/clinicalneurol.cn-001195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We analyzed 14 patients in our hospital, who underwent levodopa-carbidopa intestinal gel (LCIG) treatment through a percutaneous endoscopic gastrojejunostomy (PEG-J). The PEG-J related complications were observed in 10 patients (71.4%). Detailed complications are as followings: J-tube related complications such as kinking (3 cases, 21.4%), pump malfunctions (3 cases, 21.4%), skin troubles in the gastrostoma (7 cases, 50.0%), duodenal perforation, peritonitis, and ulcers (2 cases, 14.3%). These results indicated that the sufficient care for PEG-J associated complications are important in LCIG treatment.
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Affiliation(s)
| | - Shinichiro Shinzaki
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University
| | - Kensuke Ikenaka
- Department of Neurology, Graduate School of Medicine, Osaka University
| | - Kuni Konaka
- Department of Neurology, Graduate School of Medicine, Osaka University
| | - Daisuke Hirozawa
- Department of Neurology, Graduate School of Medicine, Osaka University
| | - Teruyuki Ishikura
- Department of Neurology, Graduate School of Medicine, Osaka University
| | - Makoto Hideshima
- Department of Neurology, Graduate School of Medicine, Osaka University
| | - Tomohito Nakano
- Department of Neurology, Graduate School of Medicine, Osaka University
| | - Takaya Kitano
- Department of Neurology, Graduate School of Medicine, Osaka University
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University
| | - Hideki Mochizuki
- Department of Neurology, Graduate School of Medicine, Osaka University
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Cerrone P, Marchese M, Pistoia MA, Marini C. Phytobezoar and duodenal ulcer as complication of Duodopa therapy in a patient affected by Parkinson's disease. BMJ Case Rep 2018; 2018:bcr-2017-223884. [PMID: 29960957 DOI: 10.1136/bcr-2017-223884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Continuous duodenal infusion of levodopa/carbidopa intestinal gel (LCIG) is an established treatment to control motor fluctuations in Parkinson's disease. Duodenal infusion allows a steady absorption of the drug in the small bowel, reducing plasmatic fluctuations of levodopa. Some complications may occur during the treatment, often related to intrajejunal percutaneous endoscopic gastrostomy (PEG-J). We report a case of duodenal ulcer associated with a phytobezoar involving the end of jejunal probe, in a patient who underwent PEG-J for LCIG infusion. In the last 2 weeks, the patient suffered from abdominal pain and dyspepsia. Oesophagogastroduodenoscopy showed an ulcerative lesion of the duodenum due to traction of the jejunal tube; the end of the jejunal tube was wrapped in a phytobezoar. This case is interesting because of the extension of the ulcerative lesion due to PEG-J dislocation and because of the subtle symptoms associated with it.
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Affiliation(s)
- Paolo Cerrone
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,ASL 1 Avezzano Sulmona l'Aquila, Neurology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Michele Marchese
- ASL 1 Avezzano, Sulmona L'Aquila, Surgical and Diagnostic Endoscopy Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Maria Antonietta Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,ASL 1 Avezzano, Sulmona L'Aquila, Surgical and Diagnostic Endoscopy Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Carmine Marini
- ASL 1 Avezzano Sulmona l'Aquila, Neurology Unit, San Salvatore Hospital, L'Aquila, Italy.,Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Cossu G, Sarchioto M, Melis M, Manca D, Sitzia L, Melis M, Carreras P. The Long Way of a “Lost Pigtail”: A Unique Complication of J-Tube in Duodopa Therapy. Mov Disord Clin Pract 2018; 5:101-102. [DOI: 10.1002/mdc3.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/17/2017] [Accepted: 09/23/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Giovanni Cossu
- Neurology Service and Stroke Unit; AO Brotzu Hospital; Cagliari Sardinia Italy
| | - Marianna Sarchioto
- Neurology Service and Stroke Unit; AO Brotzu Hospital; Cagliari Sardinia Italy
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Sardinia Italy
| | - Marta Melis
- Neurology Service and Stroke Unit; AO Brotzu Hospital; Cagliari Sardinia Italy
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Sardinia Italy
| | - Davide Manca
- Neurology Service and Stroke Unit; AO Brotzu Hospital; Cagliari Sardinia Italy
| | - Loredana Sitzia
- Digestive Endoscopy Service; AO Brotzu Hospital; Cagliari Sardinia Italy
| | - Maurizio Melis
- Neurology Service and Stroke Unit; AO Brotzu Hospital; Cagliari Sardinia Italy
| | - Pierpaolo Carreras
- Digestive Endoscopy Service; AO Brotzu Hospital; Cagliari Sardinia Italy
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Mackinnon RE. The complications of jejunostomy tubes for patients receiving Duodopa: New challenges for neuroscience nurses. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2017. [DOI: 10.21307/ajon-2017-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Russo P, Costa M, Silva M, de Sousa A, Carvalho D, Saiote J, Mendes M. Fistulization of J-PEG Jejunal Tube into the Colon in a Patient Treated with Duodopa® Infusion: A Case Report. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2017; 24:147-150. [PMID: 28848800 DOI: 10.1159/000452694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/26/2016] [Indexed: 11/19/2022]
Abstract
The continuous delivery of a levodopa/carbidopa gel suspension (Duodopa®) into the small bowel through a jejunal tube inserted via percutaneous endoscopic gastrostomy represents a new treatment method in advanced Parkinson disease. Some severe device-related complications have been described in the last few years. Some of them are associated with phytobezoar formation at the pigtail of the catheter. We present the case of a Parkinson disease patient treated with the Duodopa infusion system complicated by jejunal tube fistulization into the colon. We suggest a possible treatment strategy for this complication, which has not been described in the literature to date.
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Affiliation(s)
- Pedro Russo
- Department of Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Mariana Costa
- Department of Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Mário Silva
- Department of Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ary de Sousa
- Department of Neurology, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Diana Carvalho
- Department of Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Joana Saiote
- Department of Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Milena Mendes
- Department of Transplantation Unit, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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Abstract
INTRODUCTION The search for consistent, effective treatments in Parkinson's disease (PD) is ongoing. The importance of continuous dopaminergic stimulation (CDS) is understood to underlie best medical therapy for PD by providing closer replication of physiological patterns of dopamine release in healthy brains. AREAS COVERED An overview of interventions to improve motor fluctuations in PD is presented. Significant improvements in off-time are achieved by providing continuous therapy using targeted deep brain stimulation (DBS), subcutaneous apomorphine infusion and carbidopa/levodopa enteral suspension (Duopa). Duopa is a newly approved treatment in the US for advanced PD that delivers levodopa pumped to the intestinal tract through a percutaneous gastrostomy with jejunum tube extension (PEG-J tube). Trials with carbidopa/levodopa enteral suspension show improvement in motor fluctuations, reduction in plasma levodopa variation and improvement in overall "on" time compared with oral immediate release formulation of carbidopa/levodopa. EXPERT OPINION The degree of improvement in number of off hours per day on carbidopa/levodopa enteral suspension infusion rivals that seen with DBS and apomorphine infusion and makes this new treatment a valuable option in advanced fluctuating PD patients, especially those who are neither candidates for DBS or who do not have access to apomorphine infusion therapy or who have failed either or both therapies.
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Affiliation(s)
- Lauren C Seeberger
- a Department of Neurology , University of Colorado , Denver , CO 80045 , USA
| | - Robert A Hauser
- b Department of Neurology , Molecular Pharmacology and Physiology, University of South Florida , Tampa , FL 33613 , USA
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