Objective: To investigate clinical outcome and possible complications of LCIG in patients with advanced PD in years 2006-2014 at Helsinki University Hospital.

Background: Continuous levodopa-carbidopa intestinal gel (LCIG) is effective treatment in advanced Parkinson’s disease (PD) to diminish “off” time and dyskinesia. However, technical complications related to percutaneous endoscopic gastrostomy with jejunal extension tube (PEG-J) are quite common.

Methods: Patients with advanced PD were selected. If nasojejunal test tube trial was successful, PEG-J was placed in the endoscopy unit and LCIG was administered with a portable infusion pump. After dose optimization, the response was controlled with phone contacts and follow up visits after 6 months. Retrospective analysis of patient demographics, PEG-J procedures, discontinuation of LCIG, complications and mortality were performed.

Results: Sixty patients (mean age 68 years; mean PD duration: 11 years) had LCIG with mean duration of 26 (range 1-108) months. In 80% (n =49) of the patients, the pump was on 16 hour/day and in 11(20%) the pump was on 24 hour/day. After 6 months the mean levodopa-equivalent daily dose (LEDD) rose by 30% compared to pre-LCIG LEDD. Based on clinical evaluation most of the patients had a positive response with the LCIG treatment. Sixty patients underwent 165 PEG-J procedures. Eleven (18%) patients had early (<30 day) complication. 48 (80%) patients had 143 complications: 46 (77%) patients had 119 PEG-J or peristomal and 22 (37%) patients had 25 other complications. The most common complications were accidental removal of the inner tube in 23 (38%) and ≥5% weight loss in 18 (30%) patients. Fifteen patients (25%) discontinued the LCIG after 21 (range 0.5-69) months, and two of them later died. In the end of follow up time of mean 33 (range 3-113) months, 7 patients had LCIG until death and 38 patients were still on LCIG. Mortality was 15% (n = 9).

Conclusions: LCIG treatment was beneficial in most patients. LEDD increased by 30% after 6 months of LCIG compared to pre-LCIG level. Majority (80%) of the patients had complications leading to multiple endoscopic procedures. Close co-operation between neurologic and endoscopic units is required. Both units must be prepared for common PEG-J problems, when LCIG treatment is carried out for PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-carbidopa-intestinal-gel-via-peg-j-for-advanced-parkinsons-disease-a-single-centre-experience/