Complications Associated with Intestinal Infusion Therapies in Patients with Parkinson's Disease: A Single-Center Retrospective Study and 15-Year Experience

Igor Straka^1*Zuzana Andre¹Zuzana Kosutzka¹Karin Gmitterova¹Milos Stevove²Zuzana Durkovicova²Radovan Juricek²Peter Valkovic¹Michal Minar¹

• ¹2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
• ²3rd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia

Introduction: Parkinson's disease (PD) is a progressive neurodegenerative disorder, in advanced stages characterized by motor and nonmotor fluctuations, significantly impacting patients' quality of life (QoL). Advanced therapies, such as levodopa/carbidopa intestinal gel or carbidopa/levodopa enteral suspension (LCIG/CLES) and levodopa/entacapone/carbidopa intestinal gel (LECIG), offer continuous levodopa administration to reduce fluctuations and improve QoL. However, these therapies require invasive percutaneous endoscopic gastrostomy with jejunal extension (PEG-J), which can lead to complications. This study aimed to analyze the incidence of complications related to gastrojejunostomy in patients treated with LCIG/CLES or LECIG and their impact on therapy outcomes. Methods: This retrospective study included PD patients treated with LCIG/CLES or LECIG at our center over 15 years. Patients were included if they had a PEG-J inserted and had been on LCIG/CLES or LECIG for at least three months. Complications were analyzed to identify trends and practical solutions for management. Results: Of 111 PEG-J insertions, we analyzed 106 patients treated with LCIG/CLES or LECIG. A total of 77.4% experienced at least one adverse event (AE), predominantly device-related (69.8%). Common complications included knotting (24.4%), disconnection (22.8%), and occlusion (17.1%) of the inner tube. Serious AEs were rare but included three deaths within 30 days post-procedure, severe skin phlegmon in two patients, and severe gastrointestinal discomfort in one patient. The duration of PEG-J significantly correlated with AEs. Conclusion: Gastrojejunostomy-related AEs in LCIG/CLES and LECIG therapies are common but generally manageable with proper intervention. Serious complications are rare, with less than 10 % discontinuing treatment due to dissatisfaction.