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Anterograde colonic irrigations by percutaneous endoscopic caecostomy in refractory colorectal functional disorders

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

Percutaneous endoscopic caecostomy for antegrade colonic enemas improves significantly the quality of life of patients with colorectal disorder refractory to medical treatment.

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Acknowledgements

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.

Funding

The authors have not received any funding for this study.

Author information

Author notes

  1. Frank Zerbib and Emmanuel Coron contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Digestive Oncology, Centre Médico-chirurgical Magellan, Bordeaux University Hospital, and Université de Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM), CIC, 1401, Bordeaux, France

    Julie Ricard, Edouard Chabrun & Frank Zerbib

  2. Institut des Maladies de l’Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France

    Lucille Quénéhervé, Marc Le Rhun, Emilie Duchalais-Dassonneville, Guillaume Meurette, Yann Touchefeu, Stanislas Bruley des Varannes & Emmanuel Coron

  3. Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France

    Lucille Quénéhervé, Chloé Lefevre, Emilie Duchalais-Dassonneville, Yann Touchefeu, Stanislas Bruley des Varannes & Emmanuel Coron

Authors
  1. Julie Ricard
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  2. Lucille Quénéhervé
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  3. Chloé Lefevre
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  4. Marc Le Rhun
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  5. Edouard Chabrun
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  6. Emilie Duchalais-Dassonneville
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  7. Guillaume Meurette
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  8. Yann Touchefeu
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  9. Stanislas Bruley des Varannes
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  10. Frank Zerbib
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  11. Emmanuel Coron
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Corresponding author

Correspondence to Lucille Quénéhervé.

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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.

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Ricard, J., Quénéhervé, L., Lefevre, C. et al. Anterograde colonic irrigations by percutaneous endoscopic caecostomy in refractory colorectal functional disorders. Int J Colorectal Dis 34, 169–175 (2019). https://doi.org/10.1007/s00384-018-3183-7

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  • DOI: https://doi.org/10.1007/s00384-018-3183-7

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