Duodopa infusion treatment: a point of view from the gastroenterologist

In patients with advanced Parkinson's disease, the continuous delivery to the small intestine via a jejunal tube of levodopa/carbidopa, formulated as a gel suspension (Duodopa) represents a new treatment method. The continuous release results in less variability in levodopa concentrations and fewer motor fluctuations and dyskinesias than with oral administration. The method which requires a very good collaboration between the neurologist and the gastroenterologist is used with increasing frequency in selected centres especially in severe patients. First, a classic PEG gastrostomy kit is placed under propofol sedation. This allows the passage of a pig tail catheter which is deployed in the jejunum and it is attached to a portable pump via a special tubing system. We present our experience of seven cases (5 males, mean age 60 years) with a follow up of one year. One patient died due to respiratory failure and aspiration pneumonia probably related to the endoscopic procedure. At one year, all patients agreed that the neurological benefit offsets the procedure related problems and the technical issues related to the enteral infusion system.