Anterograde colonic irrigations by percutaneous endoscopic caecostomy in refractory colorectal functional disorders
- 80 Downloads
In case reports or small studies, percutaneous endoscopic caecostomy (PEC) has been proposed as an alternative to the Malone intervention to perform antegrade colonic enemas. Our goal was to assess the feasibility, efficacy, and tolerance of PEC in a large group of patients with refractory colorectal functional disorders.
From September 2006 to April 2014, all patients undergoing PEC for constipation, fecal incontinence, and incontinence after rectal resection in two expert centers were studied. The PEC procedure consisted in anchoring the caecum to the abdominal wall (caecopexy) and placing a specifically designed tube in the colonic lumen to perform antegrade enemas. The quality of life (GIQLI), constipation (Kess), and incontinence (Cleveland) scores were assessed before PEC and at 3, 6, 12, and 24 months.
A total of 69 patients were included. GIQLI scores were significantly improved in constipation group (n = 43), incontinence group (n = 19), and rectal resection group (n = 10). In the constipation group, Kess score decreased from 25.9 before PEC to 20.6 at 2 years (p = 0.01). In the incontinence and post-rectal resection groups, Cleveland scores decreased from 14.3 before PEC to 2.7 at 6 months (p = 0.01) and to 10.4 at 2 years (p = 0.04). Overall, PEC was considered successful by patients in 58%, 74%, and 90% of cases, in constipation, incontinence, and rectal resection groups, respectively. Chronic pain (52%) at the catheter site was the most frequent complication.
Percutaneous endoscopic caecostomy for antegrade colonic enemas improves significantly the quality of life of patients with colorectal disorder refractory to medical treatment.
KeywordsColorectal functional disorders Endoscopic treatment Constipation Fecal incontinence
The authors would like to thank the staff of the Digestive disease institute, especially the stomal therapy nurses Cathy Serage and Guylene Fachet, and the endoscopy staff.
The authors have not received any funding for this study.
Compliance with ethical standards
Conflict of interest
E Coron has received speaker’s fees from Cook medical and Fujifilm, and is member of the board of Medtronic. J Ricard, L Quénéhervé, C Lefevre, M Le Rhun, E Chabrun, E Duchalais-Dassonneville, G Meurette, Y Touchefeu, S Bruley des Varannes, and F Zerbib have nothing to disclose.
- 2.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(9):938–949Google Scholar
- 9.Lees NP, Hodson P, Hill J, Pearson RC, MacLennan I (2004) Long-term results of the antegrade continent enema procedure for constipation in adults. Color Dis Off J Assoc Coloproctology G B Irel 6(5):362–368Google Scholar
- 15.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). Gastroentérologie Clin Biol 23(1):25–31Google Scholar
- 18.Biyani D, Barrow E, Hodson P, Watson AJM, Maclennan I (2007) Endoscopically placed caecostomy buttons: a trial ACE procedure. Color Dis Off J Assoc Coloproctology G B Irel 9(4):373–376Google Scholar