Endoscopic management of duodenal levodopa-carbidopa therapy of advanced Parkinson's disease
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 adver...
| Autores: | , , , , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2019 |
| País: | España |
| Institución: | Instituto de Salud Carlos III (ISCIII) |
| Repositorio: | Repisalud |
| Idioma: | inglés |
| OAI Identifier: | oai:repisalud.isciii.es:20.500.12105/22649 |
| Acceso en línea: | https://hdl.handle.net/20.500.12105/22649 |
| Access Level: | acceso abierto |
| Palabra clave: | Parkinson's disease Levodopa Percutaneous endoscopic gastrostomy Continuous enteral infusion Femenino Duodenoscopía Masculino Carbidopa Gastrostomía Combinación de Medicamentos Humanos Persona de Mediana Edad Anciano Enfermedad de Parkinson Estudios Retrospectivos Antiparkinsonianos Aged Antiparkinson Agents Drug Combinations Humans Middle Aged Gastrostomy Parkinson Disease Duodenoscopy Male Female Retrospective Studies |
| Sumario: | 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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