A232 PEG-J RELATED COMPLICATIONS IN A CANADIAN OUTPATIENT INTRAJEJUNAL LEVODOPA/CARBIDOPA PROGRAM FOR ADVANCED PARKINSON’S DISEASE
Bibliographic record
Abstract
Levodopa/carbidopa intestinal gel (LCIG) has been found to significantly improve motor fluctuation in patients with advanced Parkinson’s disease (PD) by reducing “off” time and increasing “on” time without troublesome dyskinesia. LCIG is delivered continuously via an intrajejunal tube through a percutaneous entroscopic gastrotomy (PEG-J). Adverse events of LCIG treatment program have been largely attributed to the PEG-J procedure and the device, rather than the LCIG medication itself. To date, data evaluating long-term efficacy and safety are limited. This study is a quality improvement self-audit of our outpatient LCIG program at a tertiary center in Toronto, Ontario. Through this audit, we aim to describe the current outpatient PEG-J and LCIG treatment program (Figure 1), document short and long-term adverse events (AEs), hospitalization rates and frequency of PEG-J removal and/or exchange. These data will be compared with previously published inpatient treatment programs. All PD patients who underwent PEG-J insertion for LCIG therapy at Toronto Western Hospital, University Health Network between January 2015 and March 2018 were identified prospectively. Only patients who underwent PEG-J insertion for LCIG initiation as an outpatient were included. Variables of patient demographics, PD factors and PEG-J factors were collected using a standardized data collection sheet. Data were analyzed using standard descriptive statistical methods. A total of 45 patients were identified and included in the final analysis. Mean age at study recruitment was 72 years (standard deviation, SD=7 years), with a mean duration of PD of 15 years (SD=7 years). 60% of patients were male, and 40% were female. Mean time from PEG-J insertion and study inclusion was 21.95 months (SD=13.74 months). Patient medications at time of PEG-J insertion were summarized. Post-procedure complications were documented. There were no reported serious adverse events (SAEs), including post-procedure perforations, bleeds, fistulas, intra-abdominal collections or buried bumper syndrome. The study population of our outpatient PEG-J LCIG treatment program was comparable to that described in previous studies. The main relevant finding was the absence of serious adverse events. The largest cohort to date included 395 patients, with a SAE rate of 17% (68/395). We believe that the minimum 2-week delay between PEG-J insertion and initiation of LCIG to allow maturation of the fistulous tract may potentially lead to a reduction in PEG-J related complications. In conclusion, LCIG has been proven to be a promising treatment option for patients with advanced PD. This study supports that the current model the outpatient PEG-J LCIG treatment program is safe and effective. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".