The primary objective of our study was to report our experience with the placement and management of complications in patients with advanced Parkinson’s disease (PD) treated with continuous intestinal infusion of levodopa-carbidopa gel (LCIG) via gastrojejunostomy tube (PEG-J). This work was conducted through close collaboration between a neurology unit and a gastroenterology department. In addition, factors associated with system persistence, the occurrence of complications, and the need for device replacement were also analyzed.

This was a retrospective observational study conducted in patients with long-standing, advanced PD who had a PEG-J tube placed for LCIG therapy between December 2019 and June 2025. The treatment decision, made by the neurology department based on clinical status, treatment history, and patient preferences, followed a thorough discussion of potential benefits and risks. After obtaining informed consent, PEG-J placement was performed endoscopically, and LCIG therapy was initiated and adjusted during a short hospitalization period. A scheduled annual tube replacement was implemented to prevent complications, while patients and their caregivers received training on preventive measures. Malfunctions or complications were managed on an emergency basis, with or without endoscopic intervention. Statistical analysis was performed using Jamovi® software, version 2.3.

A total of 91 patients were included, accounting for 361 procedures performed over a five-year period. The male-to-female ratio was 2.37, and the mean age at the time of intervention was 68.5 ± 8.7 years. Most PEG-J tubes placed were 15 French in diameter (96.1%). The median propofol dose per procedure was 245 mg [186; 346].

Among the procedures performed:

- 57 (15.8%) corresponded to initial tube placements,

- 140 (38.8%) to scheduled annual replacements,

- 67 (18.6%) to complete endoscopic repairs under anesthesia,

- 92 (25.5%) to repairs performed without anesthesia,

- and 5 patients (1.4%) required complete tube removal due to lack of therapeutic efficacy.

One or more complications were reported in several patients, leading to partial or total device replacement (Tab.1). The median device survival at one year, prior to scheduled replacement, was estimated at 308 days (cf. Survival Curve Analysis).

Complications related to PEG-J tubes used for LCIG therapy in advanced Parkinson’s disease are frequent but generally mild. Optimal management relies on close collaboration between neurologists, gastroenterologists, healthcare providers, and caregivers to ensure early detection and effective management of complications, thereby maintaining treatment continuity and improving clinical outcomes.