2 levodopa infusion setups: Duodopa® pump vs Crono® LECIG

Intestinal gel infusion provides an option for continuous daytime therapy in Parkinson’s care when oral dosing alone may not offer consistent daytime coverage. The Crono LECIG pump delivers levodopa–carbidopa–entacapone gel (LECIG), while the Duodopa pump delivers levodopa–carbidopa gel (LCIG).

In this lesson from our Administering Parkinson's Therapy with Pumps and Pens series, you’ll see how to:

• Review the key features of the Crono LECIG and Duodopa infusion pumps
• Prepare each pump and connect the infusion components
• Start the daytime infusion using both devices
• Remove the pump and flush the probe after use

Follow this step-by-step overview so you’ll be able to confidently set up both the Crono LECIG and Duodopa systems to ensure consistent daytime coverage for your patients.

Deepen your understanding of advanced and device-assisted treatments in our Parkinson’s Masterclass: Advanced Therapeutics course.

Overview of the Crono LECIG levodopa infusion pump 

[00:00]
The Crono LECIG pump delivers levodopa, carbidopa, entacapone. It's used for patients with advanced Parkinson's disease who have severe motor fluctuations and dyskinesia. Lecigon® gel (please note that the brand name might be different in your country) is delivered directly into the intestine using a gastrojejunostomy tube called a PEG-J tube. The PEG-J tube is inserted through the abdominal wall and passes through the stomach into the small intestine.

Continuous intestinal infusion system

[00:35]
The medication Lecigon is contained in a cartridge that is connected to the pump. The pump allows Lecigon to be delivered regularly and continuously directly into the intestine. A test is first performed in a hospital via nasogastric tube to determine the effectiveness of the drug. After successful testing, the PEG-J tube is placed.

Programming flow rates on the Crono LECIG pump

[01:01]
The pump is programmed in mL/hour. Up to three different flow rates can be programmed. You can choose the continuous rate during the day, and a morning dose can be programmed independently of the bolus.

Preparing the LECIG cartridge and pump setup

[01:15]
To prepare the pump, you will need the Crono LECIG pump, a 50 mL cartridge containing 20 mg/mL levodopa, 5 mg/mL carbidopa, and 20 mg/mL entacapone, as well as hand and skin disinfectants. The cartridge needs to be stored in a fridge at 2 to 8 degrees Celsius, protected from light. It can be used for up to 24 hours after removal from the fridge.

Connecting the Crono LECIG pump to the PEG-J tube

[01:50]
To prepare the pump, place the cartridge upright onto the pump. Turn the cartridge until it clicks into place. Remove the plastic cover cap and unscrew the purple cap off the PEG-J probe. Connect the cartridge to the intestinal access, marked with ‘I’, of the Y-adapter. Hold the Y-adapter of the probe with one hand and carefully screw the cartridge and the pump onto the Y-adapter with the other hand in a clockwise direction.

Starting the Crono LECIG pump

[02:28]
To turn on the display, press any key on the pump. To turn on the pump, press and hold the on/off button. Press and hold the droplet button. Use the down arrow key to select morning dose from the menu. Press and hold the droplet button. The pump will now deliver the morning dose.

Continuous daytime levodopa infusion and bolus dosing

[02:54]
After the morning dose has been administered, the pump automatically switches to the continuous dose for the rest of the day. During the day, the patient can administer a bolus by pressing the droplet button. Put the pump in a carrying bag to wear it comfortably over the day. The pump can be worn for up to 16 hours.

Stopping the Crono LECIG pump

[03:15]
To remove the pump in the evening, turn the display on by pressing any key. Press and hold the ON/OFF key. The pump display will say “Stop”. Press the OK button to stop the infusion. Unscrew the cartridge from the intestinal tube and close the tube with the purple cap. Make sure you don't turn the PEG-J probe to avoid accidentally pulling the probe out.

Retracting the mechanism before removal

[03:47]
Press any key to turn on the display. Press and hold the OK key. The display shows the main menu. Press the lower arrow key and select End. Press OK to confirm. After 10 seconds, the piston is retracted. This process takes approximately six minutes.

Flushing the PEG-J tube after Crono LECIG therapy

[04:11]
While you are waiting for the piston to be fully retracted, complete the following steps to flush the probe. Fill two 20 mL ENFit syringes with tap water and have the adapter for the gastric access ready. Open the intestinal port, insert the syringe, and press the plunger with constant moderate downward pressure to flush the probe. After flushing, remove the syringe and close the intestinal connection.

Flushing the stomach port for a levodopa infusion

[04:50]
Now place the adapter for the stomach port onto the other syringe. Open the stomach port, insert the second syringe, and press the plunger with constant moderate pressure to flush the probe. After rinsing, remove the syringe and close the stomach port. As soon as the plunger is completely removed, the display shows “OFF”. The pump switches off automatically. Now remove the cartridge by unscrewing it.

Duodopa for levodopa/ carbidopa intestinal gel

[05:37]
A similar therapy is the Duodopa pump with levodopa/carbidopa intestinal gel. The dosage is the same, but entacapone is not included in the medications. The patient first undergoes the same procedure via a nasogastric tube to determine the effectiveness of the drug. After successful testing, a PEG-J tube is placed, so, similar to the Crono LECIG pump, the administration is via a PEG-J tube.

Duodopa system components

[06:08]
The Duodopa system includes a pump connected to a cassette with levodopa 20 mg/mL and carbidopa 5 mg/mL, and PEG-J tube. The PEG-J tube is inserted into the small intestine. The treatment is used for up to 16 hours every day while the patient is awake. The Duodopa pump is a little heavier and bigger than the Crono LECIG pump, and it does not contain Entacapone.

Connecting the cassette to the pump

[06:42]
In the morning, you need to connect a new cassette to the pump and use a coin to lock it on the side. Remove the red protection cap from the cassette tube and open all tube clamps. Connect the cassette tube to the PEG-J intestinal port connector. Make sure to twist the cassette tube rather than the PEG-J tube. 

Starting the levodopa infusion and morning dose

[07:08]
Press and hold the on/off button for three seconds until it turns on. Press and hold the start/stop button for three seconds until the text "RUN" is shown on the display. This indicates that the pump is running. Press the morning dose button twice to administer the morning dose. After finishing the morning dose, the continuous infusion will start automatically.

Stopping the Duodopa pump and disconnecting the cassette

[07:36]
In the evening, stop the infusion by pressing and holding the start/stop button for three seconds. Next, press and hold the on/off button for three seconds to turn the pump off. Disconnect the cassette tube from the PEG-J intestinal port connector. Again, make sure to twist the cassette tube rather than the PEG-J tube. Then disconnect the cassette from the pump. 

Flushing the PEG-J tube after intestinal gel infusion

[08:06]
Connect the blue connector to the intestinal tube port of the PEG-J tube. Using a flushing syringe, flush the tube with at least 40 mL of drinking water. Make sure you also flush the short PEG-J tube with about 40 mL at least once a week. Always close the lid after washing and throw away the used cassette.