Effect of percutaneous endoscopic gastrojejunostomy tube placement on levodopa pharmacokinetics

  • Noriyuki MiyaueEmail author
  • Hayato Yabe
  • Masahiro Nomoto
  • Masahiro Nagai
Letter to the Editor

Most patients with Parkinson’s disease (PD) experience motor fluctuations, including the wearing-off phenomenon, in the advanced stage. Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel (LCIG) via percutaneous endoscopic gastrojejunostomy (PEG-J) helps maintain adequate plasma concentrations of levodopa and ameliorates the motor fluctuations in patients with advanced PD. A recent study reported an effective long-term maintenance of the motor symptoms in patients with PD who received LCIG treatment [1]. However, complications related to the tube and pump are common, occasionally necessitating withdrawal of the LCIG treatment [2].

We present the case of a 71-year-old female with PD, who was the subject of a previous report on the relationship between a cascade stomach, which is a functional deformity of stomach with biloculation of the gastric cavity, and the levodopa pharmacokinetics [3]. The patient exhibited motor fluctuations, such as wearing-off phenomenon and...


Author contributions

NM and HY were involved in conception and designed the study. NM was involved in acquisition and analysis of the data. NM drafted the manuscript and HY, MNagai, MNomoto critically revised the manuscript. All authors gave the final approval of the manuscript to be published.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical compliance statement

The patient provided informed consent for publication. The authors confirm that the approval of an institutional review board was not required for this work. We confirm that we have read the Journal’s policy on ethical publication and affirm that this work is consistent with those guidelines.

Informed consent

Informed consent was obtained from the participant included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurology and Clinical PharmacologyEhime University Graduate School of MedicineTohonJapan
  2. 2.Department of NeurologySaiseikai Matsuyama HospitalMatsuyamaJapan
  3. 3.Department of NeurologySaiseikai Imabari HospitalImabariJapan

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