Operation of the percutaneous endoscopic gastrostomy-jejunostomy tube without endoscopy in patients with Parkinson’s disease on levodopa-carbidopa intestinal gel infusion therapy

Introduction Tube-related adverse events (AEs) occur frequently in patients with Parkinson’s disease (PD) receiving levodopa-carbidopa intestinal gel therapy Endoscopy has become evasive since the beginning of the coronavirus disease 2019 (COVID-19) pandemic This study aimed to evaluate methods that use the percutaneous endoscopic gastrostomy-jejunostomy (PEG-J) tubes without endoscopy Methods We included 19 patients in this study The contrast agent was injected into the PEG-J tube to clarify the AEs related to the use of the tube When the kink of the PEG-J tube was found, it was pulled approximately 5–10 cm When placing or replacing the PEG-J tube, the percutaneous endoscopic gastrostomy (PEG) tube was pushed into the gastrostomy hole to bring its tip closer to the pylorus before a new PEG-J tube was inserted into it Results The mean patient age was 63 1 ± 9 9 years, while the mean duration of PD was 16 7 ± 6 3 years Tube-related AEs included PEG-J tube kinks (32 events), connector failures (20 events), and PEG-J tube entanglements without/with bezoars (9 events/5 events) All PEG-J tube kinks were resolved by tube manipulation with a fluoroscopic guide In 66 of 85 events (77 6%), the PEG-J tube was placed or replaced without endoscopy We believe that the use of the antispasmodic agent just before PEG-J operation reduced this rate Conclusion Our methods were able to resolve most AEs associated with PEG-J tube use without endoscopy