Long term outcome of antegrade colonic enema (ACE) stoma for treatment of constipation and fecal incontinence in children

Keshtgar, Alireza S.; Nellihela, Leel; Wright, Hannah

doi:10.1016/j.jpedsurg.2022.07.004

Cited by 11 publications

(3 citation statements)

References 25 publications

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“…This introduces both participation and recall bias and makes it difficult to compare these data with our prospective data. Other studies report conflicting findings, some reporting equal or higher failure rates in children with FC, while others, as noted before, report an association between poor outcome and a history of Hirschsprung disease (7,10,11). These differences may be secondary to differences in patient selection, work-up, and prior treatment before initiation of ACE.…”

Section: Discussionmentioning

confidence: 92%

Long-Term Outcomes of Antegrade Continence Enemas to Treat Constipation and Fecal Incontinence in Children

Baaleman

Vriesman

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: The objective of this study is to investigate long-term outcomes of antegrade continence enema (ACE) treatment in children with constipation or fecal incontinence. Methods: Prospective cohort study including pediatric patients with organic or functional defecation disorders who started ACE treatment. Data were collected at baseline and at follow-up (FU) from 6 weeks until 60 months. We assessed parent and patient-reported gastrointestinal health-related quality of life (HRQoL) using the Pediatric Quality of Life Inventory Gastrointestinal Symptoms Module (PedsQL-GI), gastrointestinal symptoms, adverse events, and patient satisfaction. Results: Thirty-eight children were included (61% male, median age 7.7 years, interquartile range 5.5–12.2). Twenty-two children (58%) were diagnosed with functional constipation (FC), 10 (26%) with an anorectal malformation, and 6 (16%) with Hirschsprung disease. FU questionnaires were completed by 22 children (58%) at 6 months, 16 children (42%) at 12 months, 20 children (53%) at 24 months, and 10 children (26%) at 36 months. PedsQL-GI scores improved overall with a significant increase at 12- and 24-month FU for children with FC and a significant increase in parent reported PedsQL-GI score at 36-month FU for children with organic causes. Minor adverse events, such as granulation tissue, were reported in one-third of children, and 10% of children needed a surgical revision of their ACE. The majority of all parents and children reported that they would “probably” or “definitely” choose ACE again. Conclusion: ACE treatment is perceived positively by patients and parents and can lead to long-term improvement in gastrointestinal HRQoL in children with organic or functional defecation disorders.

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Section: Discussionmentioning

confidence: 92%

Long-Term Outcomes of Antegrade Continence Enemas to Treat Constipation and Fecal Incontinence in Children

Baaleman

Vriesman

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Of patients with FC referred to a pediatric surgeon, 26-38% are neurodiverse with an associated neurologic (12%) or psychiatric (26%) diagnosis or behavioral concerns [48][49][50]. The statement that these conditions can affect the continence potential remains controversial [18,51,52] with only developmental delay having been reported to be associated with a worse prognosis for continence [18].…”

Section: Neurologic and Psychiatric Issuesmentioning

confidence: 99%

State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation

et al. 2023

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Background: Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC. Methods: A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5–10 years. Results: The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer’s procedure) can be guided with a balloon expulsion test. Conclusion: Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment.

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“…ACE-Antegrade colonic enema (ACE) stoma can be used for treatment of chronic intractable constipation and soiling in children. Studies report a significant improvement of constipation, soiling and general health of patients following formation of ACE stoma [31]. The decision needs to be taken after careful discussion between a paediatric gastrointestinal specialist and paediatric surgeon and physiologic function the colon need to be carefully studied to inform the decision.…”

Section: Laxativementioning

confidence: 99%

Managing Constipation in Children: A Comprehensive Approach for Community Nurses

Gupta

2023

J Med Clin Nurs Stud

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Constipation is a prevalent issue among children, with an estimated 3% of paediatric outpatient visits concerning this problem [1]. This paper presents a comprehensive examination of the strategies for diagnosing, investigating, and managing childhood constipation, with a focus on the role of community nurses. We explore clinical history pointers, examination findings, investigations, and treatments, emphasizing practical interventions that community nurses can implement to support affected children. Constipation is a common yet frequently overlooked paediatric condition, posing significant challenges to healthcare professionals due to its multifactorial aetiology and potential long-term consequences. This article provides a comprehensive review of the diagnostic and therapeutic strategies for managing constipation in children, emphasising the vital role of community nurses. A meticulous clinical history and detailed physical examination form the cornerstone of diagnosis. Investigations are typically reserved for cases with atypical presentations, red flag symptoms, or when initial treatment strategies have failed. Treatment approaches are largely dependent on the severity of constipation, ranging from lifestyle and dietary modifications in mild cases to pharmacological interventions, including polyethylene glycol, lactulose, or Senna, for moderate to severe cases. Home management strategies also play a significant role in symptom control and recurrence prevention. The article underscores the role of community nurses in early detection, education, initiating management, and referral to specialist services. Considering the substantial psychological implications of constipation in children, a holistic approach addressing both physical and emotional aspects is advocated for successful management.

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Long term outcome of antegrade colonic enema (ACE) stoma for treatment of constipation and fecal incontinence in children

Cited by 11 publications

References 25 publications

Long-Term Outcomes of Antegrade Continence Enemas to Treat Constipation and Fecal Incontinence in Children

Long-Term Outcomes of Antegrade Continence Enemas to Treat Constipation and Fecal Incontinence in Children

State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation

Managing Constipation in Children: A Comprehensive Approach for Community Nurses

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