{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T22:12:04Z","timestamp":1768515124374,"version":"3.49.0"},"reference-count":47,"publisher":"Georg Thieme Verlag KG","issue":"10","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Fortschr Neurol Psychiatr"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Die verschiedenen Formen der perkutanen endoskopischen Gastrostomie (PEG) haben\n                    auch in der Neurologie eine hohe Relevanz, da die pumpengesteuerte intrajejunale\n                    L-Dopa-Gabe zu den unverzichtbaren Therapieformen bei der fortgeschrittenen\n                    Parkinsonerkrankung geh\u00f6rt. Eine optimale PEG-Anlage und Nachsorge sind daher\n                    bedeutsam f\u00fcr den Erfolg der Therapie. Die als Standard geltende intrajejunale\n                    Applikation von L-Dopa-Gel \u00fcber eine JET-PEG, d.h. eine PEG mit eingelegtem\n                    Innenkatheter bis ins Jejunum, ist allerdings aus verschiedenen Gr\u00fcnden nicht\n                    unproblematisch. Insbesondere die zum Teil erheblichen kumulierten\n                    Komplikationsraten zwingen zum \u00dcberdenken der Situation. Zu ber\u00fccksichtigen ist\n                    auch das sehr begrenzte Resorptionsgebiet des Medikamentes im Bereich der\n                    Flexura duodenojejunalis. Komplikationsursachen sind \u00fcberwiegend eine nicht\n                    optimale Anlegetechnik von PEG und Innenkatheter sowie die oft fehlende ad\u00e4quate\n                    Nachsorge.Im Folgenden werden die Details einer gegen\u00fcber der konventionellen\n                    Technik modifizierten und optimierten Applikationstechnik dargestellt, die sich\n                    in klinischen Anwendungen seit Jahren bew\u00e4hrt hat, sowie zus\u00e4tzlich eine neue\n                    Applikationsform, die Hybrid-PEG, vorgestellt. Viele der aus\n                    anatomisch\/physiologischen, chirurgischen und endoskopischen Gesichtspunkten\n                    abgeleiteten Details m\u00fcssen bei der Anlage strikt beachtet werden, um Minor- und\n                    Major-Komplikationen zu reduzieren bzw. zu vermeiden. Besondere Probleme\n                    bereiten Lokalinfektionen im Bereich der Durchtrittsstelle der PEG bis hin zur\n                    Peritonitis, Leckagen und das Buried-Bumper-Syndrom (BBS). Als besonders st\u00f6rend\n                    erweisen sich auch die relativ h\u00e4ufigen Dislokationen des Innenkatheters, was\n                    letztlich durch eine Clip-Fixation der Katheterspitze vermieden werden\n                    kann.Insbesondere durch Anwendung der Hybrid-PEG, einer Kombination von\n                    endoskopisch kontrollierter Gastropexie mit drei N\u00e4hten und folgender zentraler\n                    Fadendurchzugstechnik (FDZ) der PEG-Sonde, l\u00e4sst sich die Komplikationsrate\n                    deutlich senken und damit f\u00fcr die Patienten eine entscheidende Verbesserung\n                    erzielen. Die hier diskutierten Gesichtspunkte sind f\u00fcr alle diejenigen, die mit\n                    der Therapie der fortgeschrittenen Parkinson-Krankheit zu tun haben, von hoher\n                    Relevanz. Eine vertrauensvolle interdisziplin\u00e4re Zusammenarbeit zwischen\n                    Neurologie und Endoskopie\/Chirurgie\/Gastroenterologie ist eine Voraussetzung f\u00fcr\n                    gute klinische Ergebnisse.<\/jats:p>","DOI":"10.1055\/a-2337-3433","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T18:55:30Z","timestamp":1720032930000},"page":"403-415","source":"Crossref","is-referenced-by-count":2,"title":["Intrajejunale L-Dopa-Applikation bei der Parkinson-Krankheit:\n                    Optimierung der PEG-Anlage"],"prefix":"10.1055","volume":"93","author":[{"given":"Karl-Ernst","family":"Grund","sequence":"additional","affiliation":[{"name":"Experimentelle chirurgische Endoskopie,\n                    Universit\u00e4tsklinikum T\u00fcbingen, Universit\u00e4tsklinik f\u00fcr Allgemeine Viszeral- und\n                    Transplantationschirurgie, T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Zipfel","sequence":"additional","affiliation":[{"name":"Experimentelle chirurgische Endoskopie,\n                    Universit\u00e4tsklinikum T\u00fcbingen, Universit\u00e4tsklinik f\u00fcr Allgemeine Viszeral- und\n                    Transplantationschirurgie, T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8574-3297","authenticated-orcid":false,"given":"Wolfgang H.","family":"Jost","sequence":"additional","affiliation":[{"name":"Parkinson-Klinik Ortenau, Wolfach, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,7,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"255","DOI":"10.3233\/JPD-130186","article-title":"Levodopa in the treatment of Parkinson's disease: current status and new\n                    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