Of the 30 patients demographic and clinical features are reported in Table 1. Overall patients underwent a total of 156 PEG-J procedures, of which 20 patients had undergone at least one PEG-J replacement procedure, with a mean follow-up period of 64,4 (3–119) months, and an average of 4 replacements. Only one patient discontinued DLI due to the occurrence of a severe peripheral neuropathy. Over the follow-up period, six patients died, and the reported causes of death were unrelated to DLI. The total mean follow-up was of 21,4 months, with a range of 3 to 54 months. During a 12 months observation period, 14 patients out of 30 (46,7%) reported at least one complication. 8 patients (26,7%) complained about a stoma condition; 11 patients (13,3%) underwent 22 PEG-J replacement procedures due to complications, of which 15 were associated with the tubing system utilized, and 7 with patient related issues. In a 10-year follow-up, nineteen patients (63.3%) had a total of 185 complications, 85 of which were related to stoma issues: stomal erythema (n = 44), serous secretions (n = 20), surgical wound granuloma (n = 9), peristomal edema (n = 6), purulent secretions (n = 3), sero-ematic secretions (n = 2), candida infection (n = 1). 17 patients (56.6%) underwent a total amount of 100 PEG-J replacements due to complications, of which 82 out of 100 were associated with the tubing system utilized [tube dislocation (n = 35), external or internal bumper dislocation (n = 21), tube breaking/puncture (n = 16), device coloring (n = 8), accidental removal (n = 1), candida colonization of the tubing system (n = 1)], while the remaining 18 with patient related issues [abdominal discomfort (n = 9),

Table 1 Demographics, clinical features, PEG-J procedures and related complications

granulation tissue (n = 4), peristomal inflammation (n = 4), buried bumper syndrome (n = 1)] (Table 1). The most common reason given for replacement was J-tube dislocation (36%) in 12 patients (Table 1). A correlation analysis between complications and clinical scales (UPDRS and H&Y) during times of replacement did not find any significant values. However, the small number of patients and the retrospective design of the study could have influenced the results.

The “pull” method was adopted for 41 procedures (from 2009 to 2014) and the “push” method for 79 (from 2015 to 2019). Complications led to tube replacement in 75% of cases with “pull” and 67% of cases with “push” technique. Mean PEG-J duration was of 7,6 and 5,6 months for the “pull” and “push” methods, respectively. A comparison of clinical features for “pull” and “push” technique is reported in Table 2: a t-test (FDR corrected) showed no significant differences for age, disease duration, follow-up duration, UPDRS III score, mH&Y score and PEG-J duration. The paired t-test to compare scheduled replacements and unexpected replacements groups was significant (p < 0.05), however, after the FDR correction for variability did not showed this result due to the low number of subjects for each group (Table 2).

Table 2 PEG-J replacement procedures: “pull” and “push” methods comparison

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