Antegrade Continence Enema Alone for the Management of Functional Constipation and Segmental Colonic Dysmotility (ACE-FC): A Pediatric Colorectal and Pelvic Learning Consortium Study.

Creator(s)

Hira Ahmad
Caitlin Smith
Amanda Witte
Katelyn Lewis
Ron William Reeder
Jose Garza
Sarah Zobell
Kathleen Hoff
Megan Durham
Casey Calkins
Michael D. Rollins
Lusine Ambartsumyan
Rebecca M. Rentea, Children's Mercy HospitalFollow
Desale Yacob
Carlo Di Lorenzo
Marc A. Levitt
Richard J. Wood

Document Type

Article

Publication Date

10-2024

Identifier

DOI: 10.1055/a-2206-6508

Abstract

OBJECTIVE:  The purpose of the study was to determine if antegrade continence enema (ACE) alone is an effective treatment for patients with severe functional constipation and segmental colonic dysmotility.

METHODS:  A retrospective study of patients with functional constipation and segmental colonic dysmotility who underwent ACE as their initial means of management. Data was collected from six participating sites in the Pediatric Colorectal and Pelvic Learning Consortium. Patients who had a colonic resection at the same time as an ACE or previously were excluded from analysis. Only patients who were 21 years old or younger and had at least 1-year follow-up after ACE were included. All patients had segmental colonic dysmotility documented by colonic manometry. Patient characteristics including preoperative colonic and anorectal manometry were summarized, and associations with colonic resection following ACE were evaluated using Fisher's exact test and Wilcoxon rank-sum test.

RESULTS:  A total of 104 patients from 6 institutions were included in the study with an even gender distribution (males n = 50, 48.1%) and a median age of 9.6 years (interquartile range 7.4, 12.8). At 1-year follow-up, 96 patients (92%) were successfully managed with ACE alone and 8 patients (7%) underwent subsequent colonic resection for persistent symptoms. Behavioral disorder, type of bowel management, and the need for botulinum toxin administered to the anal sphincters was not associated with the need for subsequent colonic resection. On anorectal manometry, lack of pelvic floor dyssynergia was significantly associated with the need for subsequent colonic resection; 3/8, 37.5% without pelvic dyssynergia versus 1/8, 12.5% (p = 0.023) with pelvic dyssynergia underwent subsequent colonic resection.

CONCLUSION:  In patients with severe functional constipation and documented segmental colonic dysmotility, ACE alone is an effective treatment modality at 1-year follow-up. Patients without pelvic floor dyssynergia on anorectal manometry are more likely to receive colonic resection after ACE. The vast majority of such patients can avoid a colonic resection.

Journal Title

European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie

Volume

34

Issue

5

First Page

410

Last Page

417

MeSH Keywords

Humans; Constipation; Retrospective Studies; Female; Male; Child; Adolescent; Enema; Manometry; Treatment Outcome; Gastrointestinal Motility; Child, Preschool; Colonic Diseases; Follow-Up Studies; Colon

Keywords

Constipation; Retrospective Studies; Enema; Manometry; Treatment Outcome; Gastrointestinal Motility; Colonic Diseases; Follow-Up Studies; Colon

Recommended Citation

Ahmad H, Smith C, Witte A, et al. Antegrade Continence Enema Alone for the Management of Functional Constipation and Segmental Colonic Dysmotility (ACE-FC): A Pediatric Colorectal and Pelvic Learning Consortium Study. Eur J Pediatr Surg. 2024;34(5):410-417. doi:10.1055/a-2206-6508