Nearly 10% of children with antegrade enemas need additional procedures for constipation
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Almost 10% of children with antegrade enemas needed a subsequent procedure to manage their constipation, according to a study presented at the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition Annual Meeting.
“In a population-based cohort of children with antegrade enemas living in Ontario, Canada, over a 13-year period, nearly 10% required subsequent procedural intervention for the management of their constipation,” Michelle Gould, MD, MSc, of the department of pediatrics at the University of Toronto and the division of gastroenterology, hepatology and nutrition at The Hospital for Sick Children, said during the presentation. “The proportion of patients who were acquired subsequent procedural interventions represents an important marker of the success of antegrade enemas and a valuable prognostic detail for patients and families considering this procedure.”
Gould and colleagues used health administrative data to perform a population-based retrospective study and identified 164 patients (mean age, 9.5 years; 9.4% boys) who underwent antegrade enema insertion. Of these patients, 72 underwent antegrade enema insertion with appendicostomy and 92 with cecostomy. Patients were followed for a median of 4.7 years. Investigators used procedural billing codes to identify the children and then verified with manual chart review.
In addition, investigators collected data on all procedures completed from the time of enema insertion. Procedures that were constipation-related were determined using a list of Canadian Classification of Health Interventions codes. Adjusting for age, sex, type of antegrade enema and indication for insertion, logistic regression models were used to determine the correlation between clinical predictors and a need for constipation-related procedures after antegrade enema insertion.
Investigators found in 117 cases, the reason for enema insertion was an organic defecation disorder and, in 47 cases, the reason was functional constipation. There were 16 patients who needed subsequent procedural intervention and underwent 27 subsequent constipation-related procedures.
Gould and colleagues noted the mean time from enema insertion to first subsequent constipation-related procedure was 921.4 days, with the most common procedure being ileostomy formation (n = 14). Fewer than six patients needed colostomy, partial colectomy, total colectomy, anal sphincter botulinum toxin injection and transcutaneous electrical nerve stimulation.
According to researchers, underlying diagnosis of functional constipation was the only predictor of the new for a subsequent intervention (OR = 6.51; 95% CI, 2.07 to 20.52). Among patients with functional constipation, 10 needed constipation-related procedures compared with six patients with organic defecation disorders.
“Moving forward with further work, we may be able to better predict who would most benefit from this procedure, and larger cohorts with more granular clinical information such as results from manometry studies may help us to identify if particular clinical features lead some children with functional constipation to be more likely to require procedures than others,” Gould concluded.
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Gould M, et al. Abstract 457. Presented at: North American Society for Pediatric Gastroenterology, Hepatology & Nutrition Annual Meeting; Dec. 12-18, 2021 (virtual meeting).
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