Long‐term Follow‐up of Patients After Antegrade Continence Enema Procedure

Abstract

Background Antegrade continence enema (ACE) has become an important therapeutic modality in the treatment of intractable constipation and fecal incontinence. There are little data available on the long-term performance of the ACE procedure in children. Methods A retrospective review of patients who underwent the ACE procedure was conducted. Irrigation characteristics and complications were noted. Outcome was assessed for individual encounters based on frequency of bowel movements, incontinence, pain, and predictability. Results One hundred seventeen patients underwent an ACE. One hundred five patients had at least 6 months of follow-up, and were included in the analysis. Diagnoses included myelodysplasia (39%), functional intractable constipation (26%), anorectal malformations (21%), nonrelaxing internal anal sphincter (7%), cerebral palsy (3%), and other diagnoses (4%). The average follow-up was 68 months (range 7–178 months). At the last follow-up, 69% of patients had successful bowel management. Of the 31% of patients who did not have successful bowel management, 20% were using the ACE despite suboptimal results, 10% required surgical removal, and 2% were not using the ACE because of behavioral opposition to it. Patients were started on normal saline, but were switched to GoLYTELY (PEG-3350 and electrolyte solution) if there was an inadequate response (61% at final encounter). Additives were needed in 34% of patients. The average irrigation dose was 23 ± 0.7mL/kg. The average toilet sitting time was 51.7 ± 3.5minutes, with infusions running for 12.1 ± 1.2minutes. Stomal complications occurred in 63% (infection, leakage, and stenosis) of patients, 33% required surgical revision and 6% eventually required diverting ostomies. Conclusions Long-term use of the ACE gives successful results in 69% of patients, whereas 63% had a stoma-related complication and 33% required surgical revision of the stoma.

A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients

“…4,31 The collection methods were interviews during follow-up visits 6,15,20,25,43 or telephone contacts 4,7,12,17,23,32,38 or both. 16,31,37,41 The follow-up period of SB patients after starting bowel management varied from 3, 15,19,20,22,23,41,42 over 12, 12,13,21,25,31 30 [16][17][18][27][28][29][30]34,39 and 60 months 24,32,33,35,36,40,43 to 120 months. 38,43 To explore different treatment modalities for bowel management in SB and their effectiveness the studies were grouped according to the treatment modality: conservative bowel management (16 studies), electrical stimulation (4 studies) and non-conservative (surgical) bowel management (17 studies).…”

“…Redo surgery for complications varied from 5 29,38 over 10% 27,36,40 to an even higher rate of 30%. 28,31,32,42 Overall redo surgery was necessary in 23% (142/616) of patients.…”

“…[28][29][30]33,35,36,[38][39][40] If reported, it varied from 30 27,37,43 to 50 min. 31,32,34,[41][42][43] Complications are an important issue in case of surgical treatment. The complication rate varied widely.…”

“…28,[30][31][32][35][36][37][38][39]43 Some studies (5/17) gave no definition for fecal pseudo-continence 27,29,33,40,41 or a less-strict definition. 42 One study evaluated incontinence with a 5-point Likert scale. 34 The reports on achieving fecal pseudo-continence using nonconservative bowel management varied from 60 (only adults) 43 to 94%.…”

Removal of a knotted catheter lodged in an appendicostomy tract

“…The antegrade continence enema, first described by Malone et al [1], has been used with increasing frequency and with long-term success in the treatment of refractory constipation [2]. If an antegrade continence enema is administered through a surgically created appendicostomy, the patient typically catheterizes the appendicostomy tract daily to infuse the prescribed enema solution.…”