Knotting of Percutaneous Endoscopic Jejunostomy Feeding Tubes in Two Patients with Parkinson’s Disease and Continuous Duodopa^® treatment

Abstract

Continuous intraduodenal infusion of levodopa/carbidopa (Duodopa^®) via PEJ tubes is increasingly used in patients with advanced stages of Parkinson’s disease. Tube-related complications such as kinking or coiling have been frequently reported. We herein describe two cases of tube dysfunction in patients with Parkinson’s disease and continuous Duodopa^® treatment due to knotting of the distal end of the tube. The mechanisms of knotting are unclear although a causative role of impaired gastrointestinal motility either by Parkinson’s disease itself or Duodopa^® treatment might be suspected.

Zusammenfassung

Die kontinuierliche intestinale Applikation von Duodopa^®, einer Kombination aus Levodopa und Carbidopa, über eine perkutane endoskopische Jejunostomie kommt v. a. bei Patienten mit fortgeschrittener Parkinsonerkrankung oder Morbus Parkinson und ungenügendem Ansprechen auf die orale Therapie zum Einsatz. Komplikationen, die das technische System betreffen, wie etwa ein Abknicken oder eine Lageänderung der Sonde, kommen relativ häufig vor. Wir berichten über 2 Fälle einer Sondendysfunktion bedingt durch Verknotung der distalen Sondenenden bei Patienten mit Parkinsonerkrankung und kontinuierlicher Duodopa^®-Therapie. Die möglichen Mechanismen einer Verknotung der Sondenenden sind nicht klar. Es kann jedoch darüber spekuliert werden, ob gerade bei dieser Gruppe von Patienten die Beeinträchtigung der gastrointestinalen Motilität durch die Parkinsonerkrankung selbst oder die Duodopa^®-Therapie eine Rolle spielen könnte.

Key words

PEJ tube - tube dysfunction - Parkinson’s disease - Duodopa

Schlüsselworter

perkutane endoskopische Jejunostomie - Sondendysfunktion - Parkinsonerkrankung - Duodopa

• References

• 1 Zopf Y, Rabe C, Bruckmoser T et al. Percutaneous endoscopic jejunostomy and jejunal extension tube through percutaneous endoscopic gastrostomy: a retrospective analysis of success, complications and outcome. Digestion 2009; 79: 92-97
• 2 Hayes MW, Fung VS, Kimber TE et al. Current concepts in the management of Parkinson disease. Med J Aust 2010; 192: 144-149
• 3 Nyholm D. Enteral levodopa/carbidopa gel infusion for the treatment of motor fluctuations and dyskinesias in advanced Parkinson’s disease. Expert Rev Neurother 2006; 6: 1403-1411
• 4 Wolfsen HC, Kozarek RA, Ball TJ et al. Tube dysfunction following percutaneous endoscopic gastrostomy and jejunostomy. Gastrointest Endosc 1990; 36: 261-263
• 5 Fahn S, Elton RL , Members of the UPDRS Development Committee. The Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M, (eds) Recent Developments in Parkinson’s Disease, Vol. 2. Florham Park, NJ: Macmillan Healthcare Information; 1987: 153-163, 293–304
• 6 Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17: 427-442
• 7 Negreanu LM, Popescu BO, Babiuc RD et al. Cutting the Gordian knot: the blockage of the jejunal tube, a rare complication of Duodopa infusion treatment. J Med Life 2010; 3: 191-192
• 8 Liao GS, Hsieh HF, Wu MH et al. Knot formation in the feeding jejunostomy tube: a case report and review of the literature. World J Gastroenterol 2007; 13: 973-974
• 9 Myers A, Thurston W, Ho CS. Spontaneous knotting of a transgastric jejunostomy tube: case report. Can Assoc Radiol J 1997; 48: 22-24
• 10 Cappell MS, Scarpa PJ, Nadler S et al. Complications of nasoenteral tubes. Intragastric tube knotting and intragastric tube breakage. J Clin Gastroenterol 1992; 14: 144-147
• 11 Jwo SC. Removal of a self-knotted feeding jejunostomy tube in a patient with tongue base cancer. Int J Oral Maxillofac Surg 2010; 39: 922-924
• 12 Frenz MB, van Heel D, Siuda G et al. Unusual malfunction of percutaneous endoscopic jejunostomy feeding tubes in patients with intestinal dysmotility. Endoscopy 2004; 36: 234-235
• 13 Carucci LR, Levine MS, Rubesin SE et al. Evaluation of patients with jejunostomy tubes: imaging findings. Radiology 2002; 223: 241-247
• 14 Tonini M, Cipollina L, Poluzzi E et al. Review article: clinical implications of enteric and central D2 receptor blockade by antidopaminergic gastrointestinal prokinetics. Aliment Pharmacol Ther 2004; 19: 379-390
• 15 Willems JL, Buylaert WA, Lefebvre RA et al. Neuronal dopamine receptors on autonomic ganglia and sympathetic nerves and dopamine receptors in the gastrointestinal system. Pharmacol Rev 1985; 37: 165-216
• 16 Greene JG, Noorian AR, Srinivasan S. Delayed gastric emptying and enteric nervous system dysfunction in the rotenone model of Parkinson’s disease. Exp Neurol 2009; 218: 154-161
• 17 Nyholm D, Lennernäs H. Irregular gastrointestinal drug absorption in Parkinson’s disease. Expert Opin Drug Metab Toxicol 2008; 4: 193-203
• 18 Ziemssen T, Reichmann H. Treatment of dysautonomia in extrapyramidal disorders. Ther Adv Neurol Disord 2010; 3: 53-67
• 19 Edwards L, Quigley EM, Hofman R et al. Gastrointestinal symptoms in Parkinson disease: 18-month follow-up study. Mov Disord 1993; 8: 83-86
• 20 Singaram C, Ashraf W, Gaumnitz EA et al. Dopaminergic defect of enteric nervous system in Parkinson’s disease patients with chronic constipation. Lancet 1995; 346: 861-864
• 21 Pfeiffer RF. Gastrointestinal dysfunction in Parkinson’s disease. Lancet Neurol 2003; 2: 107-116