From the Guidelines
For a 77-year-old patient with Parkinson's disease whose gastrostomy tube has fallen out, the endoscopic method (PEG) is recommended over percutaneous gastrostomy due to its lower complication rate, cost-effectiveness, and operating time, as supported by the ESPEN guideline on home enteral nutrition 1. The main difference between the two approaches is that percutaneous gastrostomy is typically performed under radiologic guidance without endoscopy, while endoscopic fixation (PEG) uses an endoscope to visualize the stomach from inside.
- The endoscopic approach offers better visualization of the stomach interior, potentially reducing complications like misplacement or injury to surrounding structures.
- The endoscopic method also allows for assessment of the previous stoma site and evaluation of any internal changes since the original placement. However, the final decision should consider the patient's overall condition, including their ability to tolerate sedation required for endoscopy, respiratory status, and anatomical considerations.
- If the patient has severe aspiration risk or cannot tolerate endoscopy, the percutaneous radiologic approach might be preferred. The procedure should be performed promptly, ideally within 24 hours of tube dislodgement, to prevent closure of the tract, which would necessitate a completely new placement procedure with increased risks, as indicated by the ESPEN guideline on clinical nutrition in neurology 1. The recommendation for PEG is based on a strong consensus (97% agreement) and is considered the preferred approach for gastrostomy 1.
From the Research
Percutaneous Gastrostomy vs Endoscopic Fixation
The decision between percutaneous gastrostomy and endoscopic fixation for a 77-year-old patient with Parkinson's disease, who has had a previous percutaneous gastrostomy tube fixed which has now fallen, depends on various factors.
- The patient's overall health and medical history should be considered when deciding between these two options.
- Percutaneous gastrostomy involves the insertion of a feeding tube directly into the stomach through the abdominal wall, whereas endoscopic fixation involves the use of an endoscope to guide the placement of the feeding tube.
Comparison of Effectiveness
Both percutaneous gastrostomy and endoscopic fixation can be effective for patients with Parkinson's disease, as seen in studies 2, 3, 4, 5.
- A study published in 2024 2 discussed the optimization of PEG application for intrajejunal levodopa in Parkinson's disease, highlighting the importance of optimal PEG placement and follow-up for the success of the therapy.
- Another study published in 2018 3 reported the introduction of levodopa-carbidopa intestinal gel treatment via surgical gastrostomy in a patient with Parkinson's disease, demonstrating the effectiveness of this approach.
- A 2021 study 4 described the use of per-oral image-guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease, which was found to be safe and may be advantageous.
- A 2019 study 5 evaluated the safety and outcomes of percutaneous endoscopic transgastric jejunostomy for continuous infusion of levodopa-carbidopa intestinal gel in patients with advanced Parkinson's disease, showing favorable outcomes.
Indications for Each Option
The choice between percutaneous gastrostomy and endoscopic fixation may depend on the individual patient's needs and medical history.
- For patients with advanced Parkinson's disease, percutaneous gastrostomy may be a suitable option, as seen in studies 2, 5.
- Endoscopic fixation may be preferred for patients who have had previous complications with percutaneous gastrostomy or have certain anatomical or physiological characteristics that make endoscopic fixation more suitable.
- A 2020 review 6 discussed the diagnosis and treatment of Parkinson's disease, highlighting the importance of individualized treatment approaches and the need for careful consideration of each patient's unique needs and circumstances.