Enteral Feeding Using Levodopa-Carbidopa Intestinal Gel Percutaneous Endoscopic Gastrostomy Tube Andr eane Bernier, RD, 1 Judy Dorais, MD, FRCP(C), 2 Benoit Gagnon, RN, 1 Christiane Lepage, MD, MSc, 1 Nicolas Jodoin, MD, FRCP(C), 1 Val erie Soland, MD, FRCP(C), 1 Michel Panisset, MD, DEA, FRCP(C), 1 Sylvain Chouinard, MD, FRCP(C), 1 Antoine Duquette, MD, MSc, FRCP(C) 1, * In Parkinson’s disease (PD), dysphagia has a significant influence on nutritional status. 1 When dysphagia is resistant to oral nutri- tion intervention, enteral nutrition using a percutaneous endo- scopic gastrostomy (PEG) can be considered. 2 A levodopa (L-DOPA)-carbidopa intestinal gel (LCIG) has been used to treat advanced PD using a PEG with a jejunal exten- sion (PEG-J) (AbbVie, Montr eal, Canada). We present a case in which the LCIG PEG-J was used successfully for feeding. Case Description A 71-year-old man treated with LCIG was referred because he suffered from recurring aspiration pneumonia. A swallowing evaluation showed moderate oro-pharyngeal dysphagia. Despite modified food textures, food enrichment, supplementation, and appropriate nutrition counseling, the patient experienced mod- erate-to-severe malnutrition. Enteral nutrition was initiated using a 15-Fr (5-mm) LCIG PEG-J through the gastric port. Nutrition was first adminis- tered with a feeding pump during the night while infusion of LCIG was stopped. To complement his nutritional intake, he received two boluses during the day. After a few weeks, as a result of sleeping discomfort, a new isocaloric enteral nutrition plan was established. Five boluses were administered with the feeding pump simultaneously with LCIG to mimic usual meal times. FIGURE 1 An adaptor had to be crafted to ensure compatibility between the gastric port of the LCIG PEG-J tube and the enteral nutrition tube. A: Standard PEG connection. B: LCIG PEG-J adapted for enteral nutrition (20 Fr PEG-J is required to allow for administration of medication). 1 Service de Neurologie du D epartement de M edecine,Unit e des Troubles du Mouvement Andr e-Barbeau, Centre Hospitalier de l’Universit e de Montr eal, Montr eal, Canada; 2 Service de Gastro-ent erologie du D epartement de M edecine, Centre Hospitalier de l’Universit e de Montr eal, Montr eal, Canada *Correspondence to: Dr. Antoine Duquette, Unit e des Troubles du Mouvement Andr e-Barbeau, Service de Neurologie du D epartement de M edecine, Centre Hospitalier de l’Universit e de Montr eal, 1560 rue Sherbrooke Est (GR-1177), Montr eal, Qu ebec, Canada; E-mail: antoine. duquette@umontreal.ca Keywords: Duodopa, dysphagia, enteral nutrition, gastrostomy, intestinal gel, Parkinson’s disease. Relevant disclosures and conflicts of interest are listed at the end of this article. Received 14 November 2016; revised 21 February 2017; accepted 8 March 2017. Published online 5 May 2017 in Wiley InterScience (www.interscience.wiley.com). DOI:10.1002/mdc3.12490 © 2017 International Parkinson and Movement Disorder Society 787 doi:10.1002/mdc3.12490 LETTERS: NEW OBSERVATIONS CLINICAL PRACTICE