Scientific letter
Small bowel obstruction secondary to distal migration of the intestinal probe in a patient with an endoscopic gastrostomy for continuous carbidopa-levodopa infusion
Obstrucción de intestino delgado secundaria a migración distal de la sonda intestinal en una paciente con gastrostomía endoscópica para la infusión continua de carbidopa-levodopa
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(a) Axial Computed Tomography cut, with a regular parietal thickening of the terminal ileum that protrudes the cecal base through the valve. (b) Colonoscopy exam showed a 4<span class="elsevierStyleHsp" style=""></span>cm pseudopolyploid ileal lesion that protruded through ileocecal valve. (c) H & E original magnification 400×. A diffuse proliferation of neoplastic cells is observed from medium to large size, among which macrophages can be found, resulting in “starry-sky” pattern characteristic of Burkitt lymphoma. (d) Positive staining for CD 20 in immunohistochemistry.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Emanuel José Saad, Carina Elizabeth Seculini Patiño, María Victoria Laborie, Luciana Guanchiale, Domingo Balderramo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Emanuel José" "apellidos" => "Saad" ] 1 => array:2 [ "nombre" => "Carina Elizabeth" "apellidos" => "Seculini Patiño" ] 2 => array:2 [ "nombre" => "María Victoria" "apellidos" => "Laborie" ] 3 => array:2 [ "nombre" => "Luciana" "apellidos" => "Guanchiale" ] 4 => array:2 [ "nombre" => "Domingo" "apellidos" => "Balderramo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382418300452?idApp=UINPBA00004N" "url" => "/24443824/0000004100000003/v1_201803310413/S2444382418300452/v1_201803310413/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2444382418300427" "issn" => "24443824" "doi" => "10.1016/j.gastre.2018.03.008" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1127" "copyright" => "Elsevier España, S.L.U." 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Symmetrical hyperintensities in lentiform nuclei (arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Roberto Monreal-Robles, Guillermo Delgado-García, Erik García-Valadez, Carlos R. Cámara-Lemarroy, Ingrid Estrada-Bellmann" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Roberto" "apellidos" => "Monreal-Robles" ] 1 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Delgado-García" ] 2 => array:2 [ "nombre" => "Erik" "apellidos" => "García-Valadez" ] 3 => array:2 [ "nombre" => "Carlos R." "apellidos" => "Cámara-Lemarroy" ] 4 => array:2 [ "nombre" => "Ingrid" "apellidos" => "Estrada-Bellmann" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382418300427?idApp=UINPBA00004N" "url" => "/24443824/0000004100000003/v1_201803310413/S2444382418300427/v1_201803310413/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Small bowel obstruction secondary to distal migration of the intestinal probe in a patient with an endoscopic gastrostomy for continuous carbidopa-levodopa infusion" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "169" "paginaFinal" => "170" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Arantxa Díaz Gómez, Raquel Díaz Ruiz, Óscar Nogales, Beatriz de la Casa, Carmen Fernández Alvárez, Cecilia González Asanza" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Arantxa" "apellidos" => "Díaz Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Raquel" "apellidos" => "Díaz Ruiz" "email" => array:1 [ 0 => "diaz.ruiz.r@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Óscar" "apellidos" => "Nogales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Beatriz" "apellidos" => "de la Casa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Carmen" "apellidos" => "Fernández Alvárez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Cecilia" "apellidos" => "González Asanza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Obstrucción de intestino delgado secundaria a migración distal de la sonda intestinal en una paciente con gastrostomía endoscópica para la infusión continua de carbidopa-levodopa" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 952 "Ancho" => 950 "Tamanyo" => 79326 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">TC. Pigtail probe coiled in distal ileum due to migration, conditioning severe retrograde small bowel dilation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Levodopa is the gold standard treatment for Parkinson's disease (PD). However, due to its short plasma half-life, requiring repeated doses, long-term levodopa use (usually within 5–10 years after initiating treatment) is associated with motor fluctuations and dyskinesias. Impaired gastric emptying is also common in PD patients and leads to unpredictable responses to oral medication. These facts induce disability and lower quality of life.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Therapeutic alternatives for patients with advanced PD include deep brain stimulation, continuous subcutaneous apomorphine infusion and intrajejunal levodopa-carbidopa infusion. Continuous intraduodenal/intrajejeunal infusion of a levodopa-carbidopa (L-C) gel (Duodopa®, Abbvie) – which contains levodopa 20<span class="elsevierStyleHsp" style=""></span>mg/ml plus carbidopa 5<span class="elsevierStyleHsp" style=""></span>mg/ml – improves motor fluctuations<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a> (<span class="elsevierStyleItalic">off</span> time and severity and dyskinesia), non-motor symptoms,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> autonomy for basic activities<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> and quality of life.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> This therapy is performed by placing a specific percutaneous endoscopic gastrostomy (PEG) kit (Frecka® PEG gastric set) that contains inside a 9Fr duodenal pigtail (Freka® CH9 intestinal tube) probe. This technique requires cooperation between the neurologist that sets the indication for this treatment and does a close surveillance of the patient, and the Gastroenterologist/Endoscopist that places the PEG probe and performs the surveillance and replacements of the device.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 76 year-old woman with advanced PD complicated with motor fluctuations required Duodopa® administration to control her motor symptoms. Therefore, a PEG-Duodopa was placed, with Propofol sedation, after informing the patient and her family about the benefits and the possible risks related to the procedure. Thirty minutes before the PEG-duodopa allocation, the patient received antibiotic prophylaxis with Cefazolin 2<span class="elsevierStyleHsp" style=""></span>g. It was performed without any immediate complications and lack of complications was verified by immediate endoscopic control, as usual. The patient was discharged from hospital 2 days after the procedure, with marked improvement of the motor symptoms, since PEG-duodopa was used for the first time 24<span class="elsevierStyleHsp" style=""></span>h after its allocation. After eleven days, the patient was admitted to the emergency room because of abdominal distension with pain and vomiting, which was highly suggestive of an intestinal obstruction. Plain abdominal X-ray showed the duodenal probe tip of the Freka® CH9 Intestinal Tube projected in right iliac fossa and absence of pneumoperitoneum. Severe abdominal pain persisted despite administration of analgesics, so an urgent abdominal CT was indicated to discard any other complication. It confirmed the presence of the pigtail probe coiled in the ileum due to distal migration, conditioning severe retrograde small bowel dilation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Since the patient had no response to conservative treatment, emergency surgery was indicated, performing an ileostomy, extraction of the probe and primary suture without associated complications. Ten days after surgery, after discussing the case between surgeons, endoscopists and neurologists, and with the agreement of the patient, placement of a new duodenal pigtail type probe was carried out without further complications.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Continuous L-C gel infusion is a highly effective and well accepted alternative for the treatment of advanced PD patients.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5,6</span></a> Duodenal infusion avoids problems related to delayed stomach transit. It has a similar safety profile to oral medication providing better control of motor and non motor symptoms in those cases. However, specific complications related to probe placement cannot be overlooked. They include complications related to: (a) the stoma, like infection, granuloma development, etc., (b) the gastrostomy probe, like buried bumper syndrome; and (c) the pigtail probe: distal migration, bending, or probe break. Events that involve the probe are very frequent (a study<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> described that more than 60% of the patients had at least 1 event with duodenal probe after one year with continuous L-C infusion). Distal migration is generally asymptomatic, with spontaneous anal expulsion. Perforation or intestinal obstruction<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> secondary to probe migration as in the case exposed is exceptional.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 952 "Ancho" => 950 "Tamanyo" => 79326 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">TC. Pigtail probe coiled in distal ileum due to migration, conditioning severe retrograde small bowel dilation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of the motor complications of Parkinson's disease on the quality of life" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Chapuis" 1 => "L. Ouchchane" 2 => "O. Metz" 3 => "L. Gerbaud" 4 => "F. 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| 2024 February | 9 | 2 | 11 |
| 2024 January | 13 | 1 | 14 |
| 2023 December | 9 | 2 | 11 |
| 2023 November | 10 | 2 | 12 |
| 2023 October | 17 | 4 | 21 |
| 2023 September | 7 | 1 | 8 |
| 2023 August | 13 | 1 | 14 |
| 2023 July | 6 | 3 | 9 |
| 2023 June | 17 | 1 | 18 |
| 2023 May | 25 | 5 | 30 |
| 2023 April | 28 | 1 | 29 |
| 2023 March | 20 | 2 | 22 |
| 2023 February | 14 | 8 | 22 |
| 2023 January | 30 | 14 | 44 |
| 2022 December | 5 | 5 | 10 |
| 2022 November | 15 | 6 | 21 |
| 2022 October | 15 | 6 | 21 |
| 2022 September | 16 | 6 | 22 |
| 2022 August | 10 | 11 | 21 |
| 2022 July | 8 | 7 | 15 |
| 2022 June | 8 | 5 | 13 |
| 2022 May | 8 | 3 | 11 |
| 2022 April | 11 | 8 | 19 |
| 2022 March | 9 | 11 | 20 |
| 2022 February | 22 | 5 | 27 |
| 2022 January | 37 | 3 | 40 |
| 2021 December | 26 | 13 | 39 |
| 2021 November | 10 | 6 | 16 |
| 2021 October | 27 | 14 | 41 |
| 2021 September | 9 | 12 | 21 |
| 2021 August | 12 | 7 | 19 |
| 2021 July | 9 | 7 | 16 |
| 2021 June | 7 | 11 | 18 |
| 2021 May | 13 | 10 | 23 |
| 2021 April | 13 | 17 | 30 |
| 2021 March | 11 | 4 | 15 |
| 2021 February | 11 | 5 | 16 |
| 2021 January | 8 | 11 | 19 |
| 2020 December | 16 | 7 | 23 |
| 2020 November | 6 | 5 | 11 |
| 2020 October | 4 | 3 | 7 |
| 2020 September | 7 | 6 | 13 |
| 2020 August | 6 | 8 | 14 |
| 2020 July | 7 | 10 | 17 |
| 2020 June | 7 | 6 | 13 |
| 2020 May | 8 | 6 | 14 |
| 2020 April | 6 | 4 | 10 |
| 2020 March | 7 | 5 | 12 |
| 2018 July | 0 | 0 | 0 |
| 2018 June | 1 | 0 | 1 |
Show all
