Percutaneous endoscopic caecostomy for severe constipation in adults: feasibility, durability, functional and quality of life results at 1 year follow-up

Abstract

PEC placement achieves satisfying functional and quality of life results, and allows approximately 3/4 of patients to suspend laxatives and retrograde enemas. Nevertheless, 1/4 of the patients ask for the PEC removal because of chronic wound pain. In order to improve long-term durability of the device, a better prevention of pain is required.

Percutaneous endoscopic colostomy for adults with chronic constipation: Retrospective case series of 12 patients

“…Long‐term efficacy is considerable (50%), especially when taking into account the refractory nature of symptoms. To our knowledge, this is the first reporting on longer term efficacy (mean 3.3 years) of PEC for chronic constipation . In our group, 2 patients (16.7%) experienced spontaneous relief of constipation.…”

“…A recent study on this topic described 19 patients with a 1‐year follow‐up period. Pain occurred in 47% of patients, which lead to removal of the tube in 26% . We observed pain in only 16.7% of patients.…”

“…We believe that this discrepancy can be explained by the technique used for PEC placement. The PEC technique used by Duchalais et al and Moriwaki et al includes insertion of anchors to fixate the colon to the abdominal wall, thereby potentially increasing the risk for infections and pain, and making the technique more difficult (success rates reported of 90%). The pull technique we used is based on a procedure that most endoscopists who perform PEG placements are familiar with.…”

“…Remarkably, PEC is only rarely considered as an alternative treatment for chronic refractory constipation. Only few studies have reported on efficacy and safety of PEC in chronic refractory constipation, mostly in case reports . These data are in favor of PEC, with moderate‐to‐good efficacy.…”

Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology

“…In 2006, Uno[78], described the introducer technique to reduce the incidence of wound infection. In 2015, Duchalais et al[79] published a prospective trial to evaluate the efficacy of constipation in patients undergoing percutaneous endoscopic cecostomy tube placement and reported successful results in three quarters of the patient population. However, chronic wound pain prompted the removal in the other one fourth of the patient population.…”