title: Percutaneous endoscopic caecostomy for severe constipation in adults: feasibility, durability, functional and quality of life results at 1 year follow-up.
abstract: BACKGROUND
  The percutaneous endoscopic ceacostomy (PEC) for antegrade colonic enemas (ACE) has recently been proposed as a less invasive alternative to the Malone procedure in chronic constipated patients. Although the feasibility and safety of this innovative approach has been demonstrated, its functional results remain unknown. The aim of this study was to evaluate constipation symptoms and quality of life 1 year after the PEC placement.
  
  
  METHODS
  From Oct 2007 to Apr 2011, 21 severely constipated patients who required ACE were prospectively included. They underwent endoscopic placement of Chait caecostomy catheter (Cook Medical). Patients completed standardized questionnaires to assess constipation (KESS) and quality of life (GIQLI) scores pre PEC placement and at 1 year. Adverse events and caecostomy use data were also documented.
  
  
  RESULTS
  The caecostomy catheter was successfully placed in 19 patients. Complications were all minor, including chronic wound pain (n = 9), serous leakage (n = 7), superficial wound infection (n = 2) and accidental catheter removal (n = 2). Chronic wound pain led to definitive catheter removal in 5 (26 %) patients. One patient died from unrelated cause before the end of the follow-up. At 1 year, 11 (61 %) of the alive patients still performed ACE. During the period of ACE administration, 14 (74 %) patients suspended use of laxatives and retrograde irrigations. Constipation and quality of life scores were available in 15 patients. Median KESS score improved from 25 (12-39) before PEC to 17 (6-34) 1 year after PEC (p < 0.05). Median GIQLI score increased from 69 (25-108) to 95 (48-119) (p < 0.05).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Digestive Disease, University Hospital of Nantes, 44093, Nantes, France, emilie.duchalais@gmail.com.
authors.forename: Emilie
authors.initials: E
authors.lastname: Duchalais
authors.forename: Guillaume
authors.initials: G
authors.lastname: Meurette
authors.forename: Surendra K
authors.initials: SK
authors.lastname: Mantoo
authors.forename: Marc
authors.initials: M
authors.lastname: Le Rhun
authors.forename: Stanislas Bruley des
authors.initials: SB
authors.lastname: Varannes
authors.forename: Paul-Antoine
authors.initials: PA
authors.lastname: Lehur
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coron
mesh_terms: D000328:Adult; D000368:Aged; D002431:Cecostomy / Q000379:methods*; D002432:Cecum / Q000503:physiopathology / Q000601:surgery*; D003248:Constipation / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation / Q000502:physiology*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult