Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. 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 28:917–930

    CAS  PubMed  Google Scholar 

  2. 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 23:697–710

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  5. 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 31:938–949

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. 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 44:179–183

    Article  CAS  PubMed  Google Scholar 

  8. 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 11:302–307

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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 50:1023–1031

    Article  PubMed  Google Scholar 

  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 34:209–212

    Article  Google Scholar 

  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–e242

    Article  PubMed  Google Scholar 

  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 72:1026–1029

    Article  PubMed  Google Scholar 

  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 63:666–673

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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 43:1419–1426

    Article  CAS  PubMed  Google Scholar 

  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 82:216–222

    Article  CAS  PubMed  Google Scholar 

  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 23:25–31

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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 46:1236–1242

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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 24:454–461

    Article  PubMed  Google Scholar 

  28. Perona F, Castellazzi G, De Iuliis A, Rizzo L (2010) Percutaneous radiologic gastrostomy: a 12-year series. Gut Liver 4(Suppl 1):S44–S49

    Article  PubMed Central  PubMed  Google Scholar 

  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 15:237–244

    PubMed  Google Scholar 

  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 44:404–407

    Article  PubMed  Google Scholar 

  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 44:1575–1580

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank G. Fachet and C. Serage for the caecostomy catheter handling education and the collection of the questionnaires, and V. Wyart for his help in the collection of the clinical data.

Disclosures

E. Duchalais, G. Meurette, S. K. Mantoo, M. Le Rhun, S. B. des Varannes, P. A. Lehur and E. Coron have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Institute of Digestive Disease, University Hospital of Nantes, 44093, Nantes, France

    Emilie Duchalais, Guillaume Meurette, Marc Le Rhun, Stanislas Bruley des Varannes, Paul-Antoine Lehur & Emmanuel Coron

  2. Clinique de chirurgie digestive et endocrinienne, University Hospital of Nantes, 44093, Nantes, France

    Emilie Duchalais, Guillaume Meurette, Surendra K. Mantoo & Paul-Antoine Lehur

  3. Department of Gastroenterology and Hepatology, University Hospital of Nantes, 44093, Nantes, France

    Marc Le Rhun, Stanislas Bruley des Varannes & Emmanuel Coron

Authors
  1. Emilie Duchalais
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guillaume Meurette
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Surendra K. Mantoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc Le Rhun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stanislas Bruley des Varannes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul-Antoine Lehur
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emmanuel Coron
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emilie Duchalais.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duchalais, E., Meurette, G., Mantoo, S.K. et al. Percutaneous endoscopic caecostomy for severe constipation in adults: feasibility, durability, functional and quality of life results at 1 year follow-up. Surg Endosc 29, 620–626 (2015). https://doi.org/10.1007/s00464-014-3709-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3709-1

Keywords

Search

Navigation