Use of percutaneous endoscopic colostomy (PEC) to treat sigmoid volvulus: a systematic review

 

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Background and aim: Percutaneous endoscopic colostomy provides an alternative management option for patients with recurrent sigmoid volvulus who are considered too high risk to undergo surgery. We reviewed the literature to assess whether the National Institute for Health and Clinical Excellence guidelines published in 2006 supporting the use of percutaneous endoscopic colostomy are still valid.

Methods: A systematic literature search was conducted using PubMed, Web of Science, and Embase. The exploded search terms “Percutaneous Endoscopic Colostomy” and “Sigmoid Volvulus” were used. Librarian support was used to ensure the maximum number of relevant articles were returned. Identified abstracts were then analyzed and included if they met the inclusion criteria.

Results: Five observational studies and 5 case reports were identified that met the inclusion criteria. They provided data on 56 patients with recurrent sigmoid volvulus treated with percutaneous endoscopic colostomy placement. Sixteen of the 56 patients were treated with a single percutaneous endoscopic colostomy (PEC) tube while 38 patients were treated with 2 PEC tubes. For 2 patients the details of the procedure were unknown. Five patients developed major complications following the procedure: 1 patient developed peritonitis after 4 days, due to fecal contamination secondary to tube migration and 2 patients with cognitive impairment pulled their PEC tubes out. Two other patients died following PEC insertion. Nine patients developed minor complications following the procedure. The most commonly reported minor complication was infection at the PEC site. Four of 56 patients developed a recurrent sigmoid volvulus with a PEC tube in situ.

Conclusion: Although in these case series there is a 21 % risk of morbidity and 5 % risk of mortality from the use of a PEC, this is favorable compared to the mortality risk of 6.6 % to 44 % reported with operative intervention. This review of contemporary literature therefore supports the use of PEC in frail and elderly patients.

• References

• 1 Kulkarni K, Lakhani N, Cope A et al. A growing abdominal problem. BMJ 2013; 347: f4547
  CrossrefPubMedGoogle Scholar
• 2 Khan MAS, Ullah S, Beckly D et al. Percutaneous endoscopic colostomy (PEC): An effective alternative in high risk patients with recurrent sigmoid volvulus. J Coll Physicians Surg Pak 2013; 23: 806-808
  PubMedGoogle Scholar
• 3 Mullen R, Church N, Yalamarthi S. Volvulus of the sigmoid colon treated by percutaneous endoscopic colostomy. Surg Laparosc Endosc Percutan Tech 2009; 19: e64-e66
  CrossrefPubMedGoogle Scholar
• 4 Safioleas M, Chatziconstantinou C, Felekouras E et al. Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly: A study of 33 cases. World J Gastroenterol 2007; 13: 921-924
  CrossrefPubMedGoogle Scholar
• 5 Ifversen AKW, Kjaer DW. More patients should undergo surgery after sigmoid volvulus. World J Gastroenterol 2014; 20: 18384-18389
  CrossrefPubMedGoogle Scholar
• 6 Larkin JO, Thekiso TB, Waldron R et al. Recurrent sigmoid volvulus – early resection may obviate later emergency surgery and reduce morbidity and mortality. Ann R Coll Surg Engl 2009; 91: 205-209
  CrossrefPubMedGoogle Scholar
• 7 Daniels IR, Lamarelli MJ, Chave H et al. Recurrent sigmoid volvulus treated by percutaneous endoscopic colostomy. Br J Surg 2000; 87: 1419
  CrossrefPubMedGoogle Scholar
• 8 Grossmann EM, Longo WE, Stratton MD et al. Sigmoid volvulus in Department of Veterans Affairs medical centers. Dis Colon Rectum 2000; 43: 414-418
  CrossrefPubMedGoogle Scholar
• 9 Madiba TE, Thomson SR. The management of sigmoid volvulus. J R Coll Surg Edinb 2000; 45: 74-80
  PubMedGoogle Scholar
• 10 National Institute for Health and Clinical Excellence. Percutaneous endoscopic colostomy. London: National Institute for Health and Clinical Excellence; 2006
  PubMedGoogle Scholar
• 11 Baraza W, Brown S, McAlindon M et al. Prospective analysis of percutaneous endoscopic colostomy at a tertiary referral centre. Br J Surg 2007; 94: 1415-1420
  CrossrefPubMedGoogle Scholar
• 12 Cowlam S, Watson C, Elltringham M et al. Percutaneous endoscopic colostomy of the left side of the colon. Gastrointest Endosc 2007; 65: 1007-1014
  CrossrefPubMedGoogle Scholar
• 13 Toebosch S, Tudyka V, Masclee A et al. Treatment of recurrent sigmoid volvulus in Parkinson’s disease by percutaneous endoscopic colostomy. World J Gastroenterol 2012; 18: 5812-5815
  CrossrefPubMedGoogle Scholar
• 14 Molina-Infante J, Fernandez-Bermejo M, Mateos-Rodriguez JM. Recurrent sigmoid volvulus and fatal peritonitis after percutaneous endoscopic sigmoidoscopy. Endoscopy 2012; 44 (Suppl. 02)
  PubMedGoogle Scholar
• 15 Al-Alawi I. Percutaneous endoscopic colostomy: a new technique for the treatment of recurrent sigmoid volvulus. Saudi J Gastroenterol 2010; 16: 120-121
  CrossrefPubMedGoogle Scholar
• 16 Choi D, Carter R. Endoscopic sigmoidopexy: a safer way to treat sigmoid volvulus?. J R Coll Surg Edinb 1998; 43: 64
  PubMedGoogle Scholar
• 17 Oren D, Atamanalp SS, Aydinli B et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum 2007; 50: 489-497
  CrossrefPubMedGoogle Scholar