title: Antegrade transverse or sigmoid colonic enema through a percutaneous endoscopic gastrostomy tube is an option in the treatment of colorectal dysfunction.
abstract: BACKGROUND
  Antegrade colonic enemas are used in patients with colorectal dysfunction resistant to conservative therapy. A number of different operative techniques are applied, but their effectiveness is by and large unknown. We therefore evaluated the long-term usefulness of the left-sided percutaneous endoscopic gastrostomy (PEG) tube method in adult patients.
  
  
  METHODS
  Twenty-one patients with colorectal dysfunction underwent insertion of a PEG tube colostomy by laparotomy between 1997 and 2006. In 2014, we evaluated how many of the patients had the tube still in place, how the patients coped with the tube, and what the reasons for the removal were.
  
  
  RESULTS
  The main indications were severe constipation or fecal incontinence mainly related to neurological diseases. In 2014, 5 out of 21 patients had the tube still in use (median follow-up 14 years, range 11-17 years) and 4 out of 5 deceased patients had had the tube in use until their death, unrelated to this treatment (median follow-up 7 years, range 0-8 years). Four out of the 5 living patients considered the benefit of the tube to be good or excellent. Tubes were removed in 11 (52%) patients for various reasons, local skin irritation being the most common.
  
  
  CONCLUSIONS
  A left-sided PEG tube colostomy was removed in over half of the patients, but despite that, it still seems to be a viable long-term option in the treatment of individual patients with colorectal dysfunction, when conservative methods are ineffective.
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, School of Medicine Tampere, PO Box 2000, 33521, Tampere, Finland. kirsi.lehto@uta.fi.
authors.forename: K
authors.initials: K
authors.lastname: Lehto
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, School of Medicine Tampere, PO Box 2000, 33521, Tampere, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Hyöty
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, School of Medicine Tampere, PO Box 2000, 33521, Tampere, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Collin
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, School of Medicine Tampere, PO Box 2000, 33521, Tampere, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Janhunen
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, School of Medicine Tampere, PO Box 2000, 33521, Tampere, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Aitola
mesh_terms: D000328:Adult; D000368:Aged; D012809:Colon, Sigmoid / Q000601:surgery; D003109:Colonic Diseases, Functional / Q000628:therapy*; D003248:Constipation / Q000628:therapy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Antegrade colonic enema; Colorectal dysfunction; Constipation; Fecal incontinence