Top

Published in:

01-03-2015

Percutaneous endoscopic caecostomy for severe constipation in adults: feasibility, durability, functional and quality of life results at 1 year follow-up

Authors: Emilie Duchalais, Guillaume Meurette, Surendra K. Mantoo, Marc Le Rhun, Stanislas Bruley des Varannes, Paul-Antoine Lehur, Emmanuel Coron

Published in: Surgical Endoscopy | Issue 3/2015

Abstract

Background

The percutaneous endoscopic ceacostomy (PEC) for antegrade colonic enemas (ACE) has recently been proposed as a less invasive alternative to the Malone procedure in chronic constipated patients. Although the feasibility and safety of this innovative approach has been demonstrated, its functional results remain unknown. The aim of this study was to evaluate constipation symptoms and quality of life 1 year after the PEC placement.

Method

From Oct 2007 to Apr 2011, 21 severely constipated patients who required ACE were prospectively included. They underwent endoscopic placement of Chait caecostomy catheter (Cook Medical). Patients completed standardized questionnaires to assess constipation (KESS) and quality of life (GIQLI) scores pre PEC placement and at 1 year. Adverse events and caecostomy use data were also documented.

Results

The caecostomy catheter was successfully placed in 19 patients. Complications were all minor, including chronic wound pain (n = 9), serous leakage (n = 7), superficial wound infection (n = 2) and accidental catheter removal (n = 2). Chronic wound pain led to definitive catheter removal in 5 (26 %) patients. One patient died from unrelated cause before the end of the follow-up. At 1 year, 11 (61 %) of the alive patients still performed ACE. During the period of ACE administration, 14 (74 %) patients suspended use of laxatives and retrograde irrigations. Constipation and quality of life scores were available in 15 patients. Median KESS score improved from 25 (12–39) before PEC to 17 (6–34) 1 year after PEC (p < 0.05). Median GIQLI score increased from 69 (25–108) to 95 (48–119) (p < 0.05).

Conclusion

PEC placement achieves satisfying functional and quality of life results, and allows approximately 3/4 of patients to suspend laxatives and retrograde enemas. Nevertheless, 1/4 of the patients ask for the PEC removal because of chronic wound pain. In order to improve long-term durability of the device, a better prevention of pain is required.

Wald A, Scarpignato C, Mueller-Lissner S, Kamm MA, Hinkel U, Helfrich I, Schuijt C, Mandel KG (2008) A multinational survey of prevalence and patterns of laxative use among adults with self-defined constipation. Aliment Pharmacol Ther 28:917–930PubMed

Tack J, Müller-Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, Galmiche J-P, Fried M (2011) Diagnosis and treatment of chronic constipation—a European perspective. Neurogastroenterol Motil 23:697–710PubMedCentralPubMedCrossRef

Ripetti V, Caputo D, Greco S, Alloni R, Coppola R (2006) Is total colectomy the right choice in intractable slow-transit constipation? Surgery 140:435–440PubMedCrossRef

Mason HJ, Serrano-Ikkos E, Kamm MA (2000) Psychological morbidity in women with idiopathic constipation. Am J Gastroenterol 95:2852–2857PubMedCrossRef

Belsey J, Greenfield S, Candy D, Geraint M (2010) Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther 31:938–949PubMed

Knowles CH, Scott M, Lunniss PJ (1999) Outcome of colectomy for slow transit constipation. Ann Surg 230:627–638PubMedCentralPubMedCrossRef

Pikarsky AJ, Singh JJ, Weiss EG, Nogueras JJ, Wexner SD (2001) Long-term follow-up of patients undergoing colectomy for colonic inertia. Dis Colon Rectum 44:179–183PubMedCrossRef

Riss S, Herbst F, Birsan T, Stift A (2009) Postoperative course and long term follow up after colectomy for slow transit constipation—is surgery an appropriate approach? Colorectal Dis 11:302–307PubMedCrossRef

Malone PS, Ransley PG, Kiely EM (1990) Preliminary report: the antegrade continence enema. Lancet 336:1217–1218PubMedCrossRef

10.

Christensen P, Buntzen S, Krogh K, Laurberg S (2001) Ileal neoappendicostomy for antegrade colonic irrigation. Br J Surg 88:1637–1638PubMedCrossRef

11.

Altomare DF, Rinaldi M, Rubini D, Rubini G, Portincasa P, Vacca M, Artor N-A, Romano G, Memeo V (2007) Long-term functional assessment of antegrade colonic enema for combined incontinence and constipation using a modified Marsh and Kiff technique. Dis Colon Rectum 50:1023–1031PubMedCrossRef

12.

Meurette G, Lehur P-A, Coron E, Regenet N (2011) Long-term results of Malone’s procedure with antegrade irrigation for severe chronic constipation. Gastroenterol Clin Biol 34:209–212CrossRef

13.

Chéreau N, Lefèvre JH, Shields C, Chafai N, Lefrancois M, Tiret E, Parc Y (2011) Antegrade colonic enema for faecal incontinence in adults: long-term results of 75 patients. Colorectal Dis 13:e238–e242PubMedCrossRef

14.

Heshmat S, DeFoor W, Minevich E, Reddy P, Reeves D, Sheldon C (2008) Use of customized MIC-KEY gastrostomy button for management of MACE stomal complications. Urology 72:1026–1029PubMedCrossRef

15.

Uno Y (2006) Introducer method of percutaneous endoscopic cecostomy and antegrade continence enema by use of the Chait Trapdoor cecostomy catheter in patients with adult neurogenic bowel. Gastrointest Endosc 63:666–673PubMedCrossRef

16.

Chait PG, Shandling B, Richards HF (1997) The cecostomy button. J Pediatr Surg 32:849–851PubMedCrossRef

17.

Rivera MT, Kugathasan S, Berger W, Werlin SL (2001) Percutaneous colonoscopic cecostomy for management of chronic constipation in children. Gastrointest Endosc 53:225–228PubMedCrossRef

18.

Rodriguez L, Flores A, Gilchrist BF, Goldstein AM (2011) Laparoscopic-assisted percutaneous endoscopic cecostomy in children with defecation disorders (with video). Gastrointest Endosc 73:98–102PubMedCrossRef

19.

Biyani D, Barrow E, Hodson P, Watson AJM, Maclennan I (2007) Endoscopically placed caecostomy buttons: a trial ACE procedure. Colorectal Dis 9:373–376PubMedCrossRef

20.

Knowles CH, Eccersley AJ, Scott SM, Walker SM, Reeves B, Lunniss PJ (2000) Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS). Dis Colon Rectum 43:1419–1426PubMedCrossRef

21.

Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmülling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222PubMedCrossRef

22.

Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J (1999) First validation of the French version of the Gastrointestinal Quality of Life Index (GIQLI). Gastroenterol Clin Biol 23:25–31PubMed

23.

Poirier M, Abcarian H, Nelson R (2007) Malone antegrade continent enema: an alternative to resection in severe defecation disorders. Dis Colon Rectum 50:22–28PubMedCrossRef

24.

Rangel SJ, Lawal TA, Bischoff A, Chatoorgoon K, Louden E, Peña A, Levitt MA (2011) The appendix as a conduit for antegrade continence enemas in patients with anorectal malformations: lessons learned from 163 cases treated over 18 years. J Pediatr Surg 46:1236–1242PubMedCrossRef

25.

Ponsky JL, Aszodi A, Perse D (1986) Percutaneous endoscopic cecostomy: a new approach to nonobstructive colonic dilation. Gastrointest Endosc 32:108–111PubMedCrossRef

26.

Lynch CR, Jones RG, Hilden K, Wills JC, Fang JC (2006) Percutaneous endoscopic cecostomy in adults: a case series. Gastrointest Endosc 64:279–282PubMedCrossRef

27.

Klaassen Z, Marshall E, Tubbs RS, Louis RG Jr, Wartmann CT, Loukas M (2011) Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions. Clin Anat 24:454–461PubMedCrossRef

28.

Perona F, Castellazzi G, De Iuliis A, Rizzo L (2010) Percutaneous radiologic gastrostomy: a 12-year series. Gut Liver 4(Suppl 1):S44–S49PubMedCentralPubMedCrossRef

29.

Kastler A, Aubry S, Piccand V, Hadjidekov G, Tiberghien F, Kastler B (2012) Radiofrequency neurolysis versus local nerve infiltration in 42 patients with refractory chronic inguinal neuralgia. Pain Physician 15:237–244PubMed

30.

Jaffray B (2009) What happens to children with idiopathic constipation who receive an antegrade colonic enema? An actuarial analysis of 80 consecutive cases. J Pediatr Surg 44:404–407PubMedCrossRef

31.

Aspirot A, Fernandez S, Di Lorenzo C, Skaggs B, Mousa H (2009) Antegrade enemas for defecation disorders: do they improve the colonic motility. J Pediatr Surg 44:1575–1580PubMedCrossRef

32.

Lynch AC, Beasley SW, Robertson RW, Morreau PN (1999) Comparison of results of laparoscopic and open antegrade continence enema procedures. Pediatr Surg Int 15:343–346PubMedCrossRef

Title: Percutaneous endoscopic caecostomy for severe constipation in adults: feasibility, durability, functional and quality of life results at 1 year follow-up
Authors: Emilie Duchalais
Guillaume Meurette
Surendra K. Mantoo
Marc Le Rhun
Stanislas Bruley des Varannes
Paul-Antoine Lehur
Emmanuel Coron
Publication date: 01-03-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3709-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Percutaneous endoscopic caecostomy for severe constipation in adults: feasibility, durability, functional and quality of life results at 1 year follow-up

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2015

The effect of divided attention on novices and experts in laparoscopic task performance

Liquid-injection for preperitoneal dissection of transabdominal preperitoneal (TAPP) inguial hernia repair

Effects of laparoscopic versus open surgery on splenic vessel patency after spleen and splenic vessel-preserving distal pancreatectomy: a retrospective multicenter study

Neuromuscular blockade improves surgical conditions (NISCO)

Erratum to: Comparative assessment of surgeons’ task performance and surgical ergonomics associated with conventional and modified flank positions: a simulation study

Camera navigation and cannulation: validity evidence for new educational tasks to complement the Fundamentals of Laparoscopic Surgery Program