Received: 03.10.2010 Accepted: 20.10.2010 J Gastrointestin Liver Dis September 2011 Vol. 20 No 3, 325-327 Address for correspondence: Lucian Negreanu Department of Gastroenterology Emergency University Hospital ‘Carol Davila’ University Bucharest Email: negreanu_99@yahoo.com Duodopa Infusion Treatment: a Point of View from the Gastroenterologist Lucian Negreanu¹, Bogdan Ovidiu Popescu², Ruxandra Doina Babiuc¹, Amalia Ene 2 , Ovidiu Alexandru Bajenaru 2 , Gabriel C. Smarandache 3 1) Department of Gastroenterology; 2) Department of Neurology; 3) Department of Digestive Surgery, Emergency University Hospital Bucharest, ‘Carol Davila’ University, Bucharest, Romania Abstract 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 luctuations 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 beneit offsets the procedure related problems and the technical issues related to the enteral infusion system. Keywords Duodopa – PEG gastrostomy – complications. Introduction Although the traditional orally administered medication represents the mainstay of therapy in Parkinson’s disease (PD), some innovative drug delivery methods have the potential to reduce or avoid many side effects of current treatment, such as dyskinesia, wearing-off type luctuations, TECHNIQuE/CASE SERIES on-off phenomena or bouts of motor freezing [1]. Several methods are used, such as delivery via rectal, intranasal, sublingual, subcutaneous or percutaneous ways [1]. In some patients with advanced PD, a treatment by continuous delivery to the small intestine via a jejunal tube of levodopa/carbidopa, formulated as a gel suspension (Duodopa®, Solvay Pharma) has been proposed [2]. The continuous delivery via an electronic portable pump attached to a special tubing system results in less variability in levodopa concentrations and fewer motor luctuations and dyskinesias than with oral administration [2]. The selection of patients implies a good cooperation between a neurologist and a gastroenterologist. First, a 24-48 hours trial of Duodopa ® is done with delivery via a nasojejunal tube. If there is a good clinical response, a classic PEG gastrostomy is placed allowing the passage of a pigtail catheter that is deployed in the jejunum. A study regarding the challenges and complications of this technique from the point of view of the gastroenterologist has never been published. We present our experience of seven cases with a follow up of one year and we discuss the main complications and the evolution of the patients after the procedure. Case series The Duodopa infusion programme started in our hospital in June 2009. The Ethics’ Committee of the hospital approved the study. All patients signed a special informed consent regarding the procedure. An international protocol regarding Duodopa® (Solvay Pharma) treatment was adopted and applied. Seven patients were included into the study (ive males) with a mean age of 60.2 years (ranges 22 and 79) (Table I). The neurology team decided on the inclusion to the programme. The patients had a gastroenterological consultation one or two days before the procedure. Technique A test of effectiveness was realized in all patients in order to avoid futile gastrostomy. This test consisted of naso-