Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Real-time 3D reconstruction CT-jejunography guided direct percutaneous endoscopic jejunostomy for levodopa-carbidopa intestinal gel treatment in a patient with prior gastrojejunostomy

Kazuhiro Tomiyasu, M.D., Ph.D.1), Takeo Oshima, M.D.1), Masami Yoshii, M.D.1), Takaki Ichikawa, M.D.1), Joji Inamasu, M.D., Ph.D.2) and Masaru Kimata, M.D.3)

1) Department of Neurology, Saiseikai Utsunomiya Hospital
2) Department of Neurosurgery, Saiseikai Utsunomiya Hospital
3) Department of Surgery, Saiseikai Utsunomiya Hospital

A 68-year-old woman with Parkinson's disease, who had previously undergone Roux-en-Y gastrojejunostomy for early gastric cancer, complained of wearing-off and troublesome dyskinesia that had progressed over 7-years. After the introduction of levodopa-carbidopa intestinal gel therapy (LCIG) by nasojejunal tube, she had a good clinical response. Percutaneous endoscopic gastrostomy with a jejunal extension tube was difficult in this case, due to lack of gastrostomy site and fibrous postoperative adhesion. We introduced LCIG by direct percutaneous endoscopic jejunostomy (D-PEJ) which offers a less invasive procedure to operative tube placement. The factors affecting the success of D-PEJ could interfere with transillumination, abdominal thickness and the location of other organs. We determined the optimum site of catheter insertion with the assistance of real-time 3D reconstruction CT-jejunography. She was discharged home on postoperative day 14 without any procedure-related complications. Real-time 3D reconstructive CT-jejunography guided D-PEJ is a useful method for a patient who benefit from LCIG with prior gastrojejunostomy.
Full Text of this Article in Japanese PDF (1119K)

(CLINICA NEUROL, 62: 298|300, 2022)
key words: Parkinson's disease, levodopa-carbidopa intestinal gel, direct percutaneous endoscopic jejunosotomy, real-time 3D CT reconstruction image

(Received: 26-Aug-21)