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

• Published in: International journal of colorectal disease Vol. 34; no. 1; pp. 169 - 175
• Main Authors: Ricard, Julie, Quénéhervé, Lucille, Lefevre, Chloé, Le Rhun, Marc, Chabrun, Edouard, Duchalais-Dassonneville, Emilie, Meurette, Guillaume, Touchefeu, Yann, Bruley des Varannes, Stanislas, Zerbib, Frank, Coron, Emmanuel
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2019; Springer; Springer Nature B.V; Springer Verlag
• Subjects: Abdominal wall; Case reports; Catheters Cecostomy / adverse effects Colon / pathology Colonic Diseases / physiopathology Colonic Diseases / therapy Device Removal Endoscopy / adverse effects Endpoint Determination Humans Middle Aged Rectal Diseases / physiopathology Rectal Diseases / therapy Therapeutic Irrigation Treatment Outcome; Chronic pain; Constipation; Endoscopy; Fecal incontinence; Gastroenterology; Gastrointestinal diseases; Hepatology; Internal Medicine; Life Sciences; Medicine; Medicine & Public Health; Original Article; Patients; Proctology; Quality of life; Rectum; Surgery; Cleveland Ohio; United States > US; Fecal incontinence; Colorectal functional disorders; Endoscopic treatment; Constipation
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-018-3183-7

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.