Prospective switch study comparing two irrigation systems for transanal irrigation in children

Abstract

Background and study aims: Transanal irrigation (TAI) is used in children to treat constipation and incontinence. Belgium has 2 systems available: Colotip® (cheaper, however not designed for TAI) or Peristeen®. Patients and methods: This patient-control switch study is the first to compare 2 TAI systems. Children regularly using Colotip® for TAI were asked to participate, after consent, a visual analogue scale (VAS) rating the system and a 2-week diary (fecal continence, self-reliance, time spent on the toilet, pain, Bristol stool scale, irrigation volume and frequency of enema) were completed. Non-parametric statistics were used. Results: Out of 26 children using Colotip®, 18 (69%) children participated and 5 refused (fear n=1, satisfaction Colotip® system n=7). Of these 18 children (interquartile range: 3-18 years, median 12.5 years, 9 girls) 5 patients stopped Peristeen® (pain n=1, fear n=1 and balloon loss n=3) and 2 were lost from follow up. Dropouts and included patients showed no statistical difference. In the 11 remaining patients, pseudo-continence (p 0.015), independence (p 0.01) and VAS score (p 0.007) were significantly better with Peristeen®, no difference was found in time spent on the toilet (p 0.288) and presence of pain (p 0.785). Conclusions: In children Peristeen® offered significantly higher pseudo-continence and independency. 30% refused participation because of satisfaction with the Colotip® and 30% spina bifida patients reported rectal balloon loss due to sphincter hypotony. To diminish Peristeen® failure, a test-catheter could be of value. Considering Colotip® satisfaction, both systems should be available. Patient selection for Peristeen® needs further research.

Transanal irrigation to manage neurogenic bowel in the pediatric population with spina bifida: a scoping review

“…22 studies selected were articles published in scientific journals, while 1 was an MS dissertation. 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 …”

“…Intestinal control led to significant improvement in urodynamic parameters (p < 0.001). Van Renterghem, 2021 43 Belgium Quasi-experimental pre-test/post-test Single center 14 SB Age:3-18 years Comparing 2 TAI systems in children with congenital diseases. Bristol Scale; Satisfaction Scale (0-10) Minimum of 2 weeks with the cone and 2 weeks with Peristeen® Use of Peristeen® : 5/7 pseudoconetinent and 2/7 socially continent; Mean satisfaction with the device 8 Cone use: 17 pseudocontinent; 4/7 socially continent; and 2 incontinent.…”

“…The FI was defined as fecal loss that takes place at least once a month 38 , 40 , 42 , 43 or as the involuntary loss of feces at least once a week. 29 , 34 , 35 Fecal pseudo continence was defined as no loss of feces in the last 6 months 31 , 36 , 43 or as fecal loss less frequently than once a week, during TAI.…”

“…The FI was defined as fecal loss that takes place at least once a month 38 , 40 , 42 , 43 or as the involuntary loss of feces at least once a week. 29 , 34 , 35 Fecal pseudo continence was defined as no loss of feces in the last 6 months 31 , 36 , 43 or as fecal loss less frequently than once a week, during TAI. 29 , 35 Social fecal continence was defined as fecal loss less frequent than once a month, 28 , 31 , 40 , 43 while fecal continence indicates no fecal loss while not undergoing treatment.…”

“… 29 , 34 , 35 Fecal pseudo continence was defined as no loss of feces in the last 6 months 31 , 36 , 43 or as fecal loss less frequently than once a week, during TAI. 29 , 35 Social fecal continence was defined as fecal loss less frequent than once a month, 28 , 31 , 40 , 43 while fecal continence indicates no fecal loss while not undergoing treatment. 29 , 35 Except for a study that used ROMA III and transrectal echography criteria 42 to determine cases of intestinal constipation, most were not based on ROMA IV criteria for this diagnosis in the pediatric population.…”