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• Vol.62 No.4
• CLINICA NEUROL, 62: 298−300, 2022
• Vol.62 No.4 contents

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)