Surgical and Experimental Endoscopy, University Hospital of Tübingen, Tübingen, Germany.
, Gottwollshaeuser Steige 25, 74523, Schwaebisch Hall, Germany.
J Neural Transm (Vienna). 2023 Nov;130(11):1383-1394. doi: 10.1007/s00702-023-02601-0. Epub 2023 Feb 21.
Pump-guided intrajejunal levodopa administration is one of the indispensable forms of therapy in advanced Parkinson's syndrome, along with deep brain stimulation and subcutaneous apomorphine injection. The standard application of levodopa gel via a JET-PEG, i.e. a percutaneous endoscopic gastrostomy (PEG) with an inserted internal catheter into the jejunum, has not been unproblematic due to the restricted absorption area of the drug in the region of the flexura duodenojejunalis and especially due to the sometimes considerable accumulated complication rates of a JET-PEG. Causes of complications are mainly a non-optimal application technique of PEG and internal catheter as well as the often missing adequate follow-up care. This article presents the details of a-compared to the conventional technique-modified and optimised application technique, which has been clinically proven successfully for years. However, many details derived from anatomical, physiological, surgical and endoscopic aspects must be strictly observed during the application to reduce or avoid minor and major complications. Local infections and buried bumper syndrome cause particular problems. The relatively frequent dislocations of the internal catheter (which can ultimately be avoided by clip-fixing the catheter tip) also prove to be particularly troublesome. Finally, using the Hybrid technique, a new combination of an endoscopically controlled gastropexy with 3 sutures and subsequent central thread pull-through (TPT) of the PEG tube, the complication rate can be dramatically reduced and thus a decisive improvement achieved for patients. The aspects discussed here are highly relevant for all those involved in the therapy of advanced Parkinson's syndrome.
经皮内镜引导下空肠置管给予左旋多巴是治疗晚期帕金森病的重要方法之一，与深部脑刺激和皮下阿朴吗啡注射并列。尽管经皮内镜引导下空肠置管（PEG）技术通过插入空肠的内置导管为左旋多巴凝胶的标准应用提供了可能，但由于十二指肠空肠曲部位药物吸收面积受限，尤其是由于经皮内镜引导下空肠置管技术的累积并发症发生率较高，该技术的应用一直存在问题。并发症的主要原因是 PEG 和内置导管的应用技术不理想以及缺乏充分的随访护理。本文介绍了一种与传统技术相比经过改良和优化的应用技术，该技术已在临床上成功应用多年。然而，在应用过程中必须严格遵守解剖学、生理学、外科学和内镜学等方面的许多细节，以减少或避免轻微和严重的并发症。局部感染和埋藏式 bumper 综合征会引起特别的问题。内置导管的相对频繁脱位（通过夹闭导管尖端可以避免）也被证明是特别麻烦的。最后，使用 Hybrid 技术，即通过 3 针内镜控制胃固定术与随后的 PEG 管中央线贯穿技术（TPT）相结合，可以显著降低并发症发生率，从而为患者带来显著改善。本文讨论的这些方面与所有参与晚期帕金森病治疗的人员都密切相关。
