Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility

Abstract

Background Antegrade continence enemas (ACE) have been used in the treatment of defecation disorders in children; little is known on their effect on colon motility and the utility of the colon manometry (CM) predicting long term ACE outcomes. Methods Retrospective review of children with constipation undergoing CM before and after ACE to evaluate CM changes and their utility on predicting ACE outcome. Results 40 patients (mean age 8.8 SD 3y and 53% female) were included; 39/40 responded to the ACE. Of these 39, 14 (36%) were dependent and 25 (64%) had decreased it (11 of those or 28% discontinued it). On repeat CM we found a significant increase in the fasting (p<0.01) and post-prandial (p=0.03) motility index, number of bisacodyl-induced high amplitude propagating contractions (HAPC’s) (p=0.03) and total HAPC’s (p=0.02). Gastrocolonic response to a meal, propagation and normalization of HAPC’s improved in 28%, 58% and 33%, respectively with CM normalizing in 33% of patients. The baseline CM did not predict ACE outcome. The presence of normal HAPC’s on the repeat CM was associated with ACE decrease. Progression and normalization of HAPC’s (p=0.01 and 0.02 respectively) and CM normalization (p=0.01) on repeat CM were individually associated with ACE decrease. No CM change was associated with ACE discontinuation. Multivariate analysis showed that older age and HAPC normalization on CM predict ACE decrease and older age is the only predictor for ACE discontinuation. Conclusions Colon motility improves after ACE and the changes on the repeat CM may assist in predicting ACE outcome.

Surgical decision-making in the management of children with intractable functional constipation: What are we doing and are we doing it right?

“…However, it has also been shown that findings of dysmotility are potentially reversible and that motility as measured by colonic manometry can improve after decompression of the colon [36][37][38]. An improvement in colonic motility has also been demonstrated to occur in patients after using ACE [39]. This suggests that colonic dysmotility may not only contribute to the severity of the constipation but may also be a consequence of long-standing constipation, possibly because of fecal stasis and colonic distension which in turn may lead to suboptimal motor function.…”

Segmental colonic dilation is associated with premature termination of high‐amplitude propagating contractions in children with intractable functional constipation

“…It is possible that this phenomenon has a multifactorial etiology and that the different clinical features are influenced by each other. This question cannot be completely answered based on the current studies, but it is important to note that dysmotility has been shown to improve after decompression of the colon in previous studies …”

An ANMS‐NASPGHAN consensus document on anorectal and colonic manometry in children

“…Colon manometry can help guiding surgical interventions such as placement of an appendicostomy or a cecostomy for the administration of antegrade colonic enemas (ACE) or creation of a diverting ileostomy. Colonic manometry has been reported to be useful in predicting successful outcomes to ACE . The value of CM in guiding partial colonic resections is debated.…”

“…Determine if a diverted colon may be re‐anastomosed . Clinical progress in combination with repeated CM testing are taken in consideration at the time of deciding which patients will benefit from reanastomosis or will require a resection. To assess the improvement of colonic dysmotility after long‐term use of ACE . Patients with poor response to ACE and abnormal colonic motility are likely to require a colonic resection.…”