Objective: Our aim is to highlight the improvement on quality of life of using a duodenal levodopa infusion. In addition, we want to emphasize the continuing repercussions on healthcare provision following the covid-19 pandemic.

Background: An 81 year old female patient (HK) was admitted to hospital with bilious vomiting and bypassing from her PEG-J stoma site. The PEG-J was inserted to facilitate infusion of duodenal levodopa for her Parkinson’s disease, which she had lived with for over 30 years. In recent years, she had severe motor fluctuations, which drastically improved with the initiation of duodenal levodopa infusion (DLI) in 2019. The Covid-19 pandemic caused unprecedented disruptions to healthcare service delivery. Procedures were cancelled and referrals were delayed because of a lack of capacity. She was admitted to hospital in 2022 with vomiting. CT imaging demonstrated intussusception of the duodenum and proximal jejunum. Dense calcified material, measuring 3 x 2.6 cm, was observed to be positioned in the jejunal lumen.

Method: HK was referred for a change of the PEG-J, but she suffered with recurrent inpatient aspiration pneumonias, which made her too unstable for intervention. Eventually, once all infections were treated, she was sent for the PEG-J change. However, the endoscopist was unable to extract the jejunal extension, and noted that the bezoar at the distal end of the jejunal extension was likely causing a degree of obstruction and was the lead point for the intussusception, which explained the patient’s obstructive symptoms.

Results: The patient case was discussed at the local gastroenterology and surgical MDT, where it was felt that the patient’s frailty and significant list of co-morbidities, denoted a risk that far outweighed the benefits. As a result, she was deemed not fit for any other endoscopic intervention nor any surgical intervention. Following discussions with the patient and her family, it was agreed that a palliative approach was to be sought. Symptom control was optimised and an advanced care plan was written.

Conclusion: Patients can find significant improvements in their quality of life with the introduction of duodenal levodopa infusion.  The consequences of the delays in healthcare provision are present several years after the heights of the covid-19 pandemic.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-bypassing-and-embedded-peg-j/