How long will I have my ACE? The natural history of the antegrade continence enema stoma in idiopathic constipation

Khoo, A. Kate; Askouni, Evita; Basson, Sonia; Ng, Jessica; Cleeve, Stewart

doi:10.1007/s00383-017-4128-x

Cited by 14 publications

(9 citation statements)

References 24 publications

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“…In addition to improvement with current symptoms, over one‐third of patients in our sample were able to bridge from ACE therapy to laxative therapy. This matches similar numbers in the nonsyndromic population, suggesting a benefit to both short‐term and long‐term outcomes from ACE therapy in these patients 24 …”

Section: Discussionsupporting

confidence: 78%

Outcomes of children with constipation and autism spectrum disorder treated with antegrade continence enemas

Srinivas,

Halaweish,

Knaus

et al. 2024

J. pediatr. gastroenterol. nutr.

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BackgroundTreatment of functional constipation (FC) in children with autism spectrum disorder (ASD) is challenging due to sensory and behavioral issues. We aimed to understand whether antegrade continence enemas (ACEs) are successful in the treatment of FC in children with ASD.MethodsA single‐institution retrospective review was performed in children diagnosed with ASD and FC who underwent appendicostomy or cecostomy placement from 2007 to 2019. Descriptive statistics regarding soiling and complications were calculated.ResultsThere were 33 patients included, with a median age of 9.7 years at the time of ACE initiation. The average intelligence quotient was 63.6 (SD = 18.0, n = 12), the average behavioral adaptive score was 59.9 (SD = 11.1, n = 13), and the average total Child Behavioral Checklist score was 72.5 (SD = 7.1, n = 10). Soiling rates were significantly lower following ACE initiation (42.3% vs. 14.8%, p = 0.04). Behavioral issues only prevented 1 patient (3.0%) from proper ACE use. Eleven patients (36.6%) were able to transition to laxatives. There were significant improvements in patient‐reported outcomes measures and quality of life.ConclusionPlacement of an appendicostomy or cecostomy for management of FC in children with severe ASD was successful in treating constipation and improving quality of life.

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Section: Discussionsupporting

confidence: 78%

Outcomes of children with constipation and autism spectrum disorder treated with antegrade continence enemas

Srinivas,

Halaweish,

Knaus

et al. 2024

J. pediatr. gastroenterol. nutr.

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“…18,32 The reason for the mixed findings across results may be that both younger age and older age are associated with negative outcomes. Khoo et al 41 suggest there may be an optimum age for ACE between 6 and 12 years old, as younger children may be unable to comply with flushes and toilet sits and teenagers may be given more independence and less supervision with completing flushes (perhaps less than is appropriate) thus leading to less treatment adherence. When considering age as a risk for ACE failure, authors primarily highlighted concerns regarding how age related to adherence.…”

Section: Pre-oper Ative Fac Tor Smentioning

confidence: 99%

“…Several studies found that when full continence was not achieved shortly after procedure, there was a higher chance for disuse of their stomas. 34,37,48 Khoo et al 41 found that patients who had fecal incontinence six weeks after ACE procedure were more likely to have their ACE closed than participants who had achieved continence at six weeks. Mugie et al 42 found that flush regimens that included laxatives were the most effective irrigation solution, and patients who started with an irrigation solution with laxatives were more likely to have success in the long-term.…”

Section: Treatment Adherencementioning

confidence: 99%

Psychosocial factors impacting antegrade continence enema outcomes in pediatric patients

Benson

Bazier

Schwartzkopf

et al. 2023

Neurogastroenterology Motil

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BackgroundChildren with constipation and encopresis are often treated with medication and behavioral approaches. When constipation persists, surgical interventions such as antegrade continence enema (ACE) procedures are considered. Many children benefit from these procedures; however, some children continue to have incontinence, experience complications, or discontinue the use of the ACE stoma. There is some evidence in the literature to indicate that psychosocial factors can have an impact on ACE outcomes; however, standardized biopsychosocial guidelines related to ACE candidacy and surgery do not currently exist.PurposeThe purpose of this review is to summarize the research to date on psychosocial factors related to ACE treatment outcomes and complications. Identifying what is known and what limitations remain can support future research to inform development of guidelines for pre‐procedure evaluations. Psychosocial pre‐procedure evaluations could help to inform eligibility for the procedure as well as interventions to enhance outcomes for children at increased risk for poor outcomes or complications from ACE. Age, psychiatric symptoms, and adherence to the ACE flush regimen were some of the factors identified in the literature as impacting ACE outcomes; however, there is limited research in this area.

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“…This suggests that colonic dysmotility may not only contribute to the etiology of FC but may also be a consequence of long-standing FC, possibly because of fecal stasis leading to suboptimal colonic motor function. 10,[13][14][15][16][17][18] Sacral Nerve Stimulation Sacral nerve stimulation (SNS) involves low-amplitude electrical stimulation of the sacral nerves. This effect can be administered via transcutaneous stimulation of the posterior tibial nerve, transabdominal stimulation, or via an electrode placed through the sacral foramen.…”

Section: Ileostomymentioning

confidence: 99%

“…or after successful antegrade irrigation. [13][14][15][16][17][18] Another factor which is under debate is whether antegrade access should accompany the resection, which may help with emptying in the short term before retrying the colon on a medical regimen. 36 There are still many reports describing major procedures to treat FC with "failure of medical management" in patients for whom an ACE was not tried first.…”

Section: Colonic Resectionmentioning

confidence: 99%

Surgical Interventions for Functional Constipation: An Update

Vilanova-Sánchez

Levitt

2020

Eur J Pediatr Surg

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Chronic idiopathic constipation, also known as functional constipation, is defined as difficult and infrequent defecation without an identifiable organic cause. Medical management with laxatives is effective for the majority of constipated children. However there is a subset of patients who may need evaluation by a surgeon. As constipation progresses, it can lead to fecal retention and rectal and sigmoid distension, which impairs normal colorectal motility. Surgical interventions are influenced by the results of: a rectal biopsy, transit studies, the presence of megacolon/megarectum on contrast enema, the degree of soiling/incontinence, anorectal manometry findings, and colonic motility evaluation. In this review, we describe the different surgical options available (intestinal diversion, antegrade enemas, sacral nerve stimulation, colonic resections, and Botulinum toxin injection) and provide guidance on how to choose the best procedure for a given patient.

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How long will I have my ACE? The natural history of the antegrade continence enema stoma in idiopathic constipation

Abstract: The ACE survival curve estimates the proportion of patients with idiopathic constipation who can expect closure (either due to success or failure) at certain timepoints. This may be useful for patient counseling. Younger age at ACE was associated with earlier closure (for success).

Cited by 14 publications

References 24 publications

Outcomes of children with constipation and autism spectrum disorder treated with antegrade continence enemas

Outcomes of children with constipation and autism spectrum disorder treated with antegrade continence enemas

Psychosocial factors impacting antegrade continence enema outcomes in pediatric patients

Surgical Interventions for Functional Constipation: An Update

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