Therapeutic utility of percutaneous cecostomy in adults: an updated systematic review (original) (raw)
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Percutaneous endoscopic cecostomy in adults: a case series
Gastrointestinal Endoscopy, 2006
Background: Percutaneous cecostomy is used to treat recurrent colonic pseudoobstruction or obstipation in children and adults with multiple medical comorbidities. Percutaneous endoscopic cecostomy is a potentially attractive alternative to surgical or fluoroscopic cecostomy placement. A few reports describe percutaneous endoscopic cecostomy for management of these problems in children, whereas there are no large series of percutaneous endoscopic cecostomy in adult patients describing the indications, complications, and outcomes.
Journal of Vascular and Interventional Radiology, 2014
Purpose: To assess the safety and efficacy of image-guided percutaneous cecostomy/colostomy (PC) in the management of colonic obstruction in patients with cancer. Materials and Methods: Twenty-seven consecutive patients underwent image-guided PC to relieve large bowel obstruction at a single institution between 2000 and 2012. Colonic obstruction was the common indication. Patient demographics, diagnosis, procedural details, and outcomes including maximum colonic distension (MCD; ie, greatest transverse measurement of the colon on radiograph or scout computed tomography image) were recorded and retrospectively analyzed. Results: Following PC, no patient experienced colonic perforation; pain was relieved in 24 of 27 patients (89%). Catheters with tip position in luminal gas rather than mixed stool/gas or stool were associated with greater decrease in MCD (À40%, À12%, and À16%, respectively), with the difference reaching statistical significance (P ¼ .002 and P ¼ .013, respectively). Catheter size was not associated with change in MCD (P ¼ .978). Catheters were successfully removed from six of nine patients (67%) with functional obstructions and two of 18 patients (11%) with mechanical obstructions. One patient underwent endoscopic stent placement after catheter removal. Three patients required diverting colostomy after PC, and their catheters were removed at the time of surgery. One major complication (3.7%; subcutaneous emphysema, pneumomediastinum, and sepsis) occurred 8 days after PC and was successfully treated with cecostomy exchange, soft-tissue drainage, and intravenous antibiotic therapy. Conclusions: Image-guided PC is safe and effective for management of functional and mechanical bowel obstruction in patients with cancer. For optimal efficacy, catheters should terminate within luminal gas. ABBREVIATIONS ACPO = acute colonic pseudoobstruction, MCD = maximum colonic distension, PC = percutaneous cecostomy/colostomy Colonic obstruction occurs in as many as 24% of patients with advanced colorectal malignancies and 42% of patients with ovarian malignancies, with 30-day operative mortality rates in patients with end-stage cancer and bowel obstruction reported as high as 40% (1). Management of colonic obstruction requires consideration of the potential benefits and risks of available invasive treatments, including the patient's life expectancy in addition to personal choices regarding the acceptability of an exteriorized catheter. The ideal treatment should provide durable palliation with minimal morbidity (2). Currently, treatment strategies are varied and include endoscopic, surgical, and interventional radiologic therapies (1-4). Percutaneous cecostomy/ colostomy (PC) has been used as an alternative to open or laparoscopic surgical cecostomy for management of adult bowel obstruction (5-7) and pediatric constipation/ fecal incontinence (8,9). Established indications of PC
International Journal of Surgery, 2013
Background: The construction of colostomy is associated with decreased physical and psychological wellbeing as well as decreased quality of life. Cecostomy is the creation of an opening in the cecum to provide colonic decompression. Objective: This work was conducted to evaluate the efficacy of tube cecostomy as an alternative to colostomy in the managing patients with left-sided colonic carcinoma and rectal cancer in terms of occurrence of postoperative morbidity and mortality and the functional outcome. Design and settings: A total number of 156 patients with colorectal cancer were enrolled in the study and were divided randomly into two equal groups. Patients: A group of 78 patients underwent tube cecostomy (group A) were compared with the other 78 patients who underwent loop colostomy (group B). The outcome parameters were the incidence of anastomotic leak, operative time, primary operation mortality rate, patient satisfaction and hospital stay. Results: The mean operating time and the mean hospital slay was significantly shorter in tube cecostomy group when compared with loop colostomy group (P < 0.05). The overall recorded morbidity for the primary operation was 12.8% and 29.5% for group A and B respectively [P ! 0.05] while the stoma related complications rate was 7.7% and 25.6% for each group respectively [P 0.05]. Conclusion: Performing tube cecostomy instead loop colostomy in managing patients with left-sided colonic carcinoma and rectal cancer can decrease the anticipated postoperative morbidity, lowers prolonged hospital stay and provides adequate functional outcome. Clinical trial registration: ACTRN12611000353998 http://www.anzctr.org.au/ACTRN12611000353998\. aspx.
Journal of Pediatric Surgery, 2018
Children failing medical management for severe constipation and/or fecal incontinence may undergo surgical intervention for antegrade enema administration. We present a modification of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure that allows primary placement of a skin-level device. Methods: A single-institution retrospective review was performed from 2009-2015. In the modified technique the colonoscope is advanced to the cecum, cecal suspension sutures are placed under laparoscopic visualization, and percutaneous needle puncture of the cecum is performed under direct laparoscopic and endoscopic visualization. A skin-level cecostomy tube is then placed over a guide wire. Patient characteristics and 30-day results were analyzed by Fisher's exact test. Results: 52 patients underwent attempted LAPEC. Successful LAPEC using both laparoscopic and endoscopic guidance was achieved in 46 (88.5%). A MIC-KEY device was placed in 38. Corflo PEG tube placement was necessary in 14 due to high BMI (mean 28.4). Colonoscopy failed to reach the cecum in 6 and laparoscopy alone was utilized to achieve successful tube placement. Cecostomy site infections occurred in 3 (5.8%), only in those undergoing PEG placement using a pull technique (p < 0.05). Conclusion: Primary placement of a skin-level device was successful in the majority of patients undergoing cecostomy tube placement for bowel management utilizing antegrade colonic enemas. This technique avoids a second anesthesia for tube conversion. Visualization via colonoscopy with the use of cecal suspension sutures is recommended. High BMI necessitates initial placement of a PEG tube and complications exclusively occurred in this group.
Gastrointestinal Intervention, 2014
Percutaneous cecostomy is mainly used to treat chronic neurogenic constipation in children. It may also be performed for emergency decompression of large bowel obstruction or to allow antegrade stenting in right-sided colonic obstruction. However, there are no dedicated or licensed tubes available for this purpose, and owing to the increased intracolonic pressure from the underlying obstruction, there is a high risk of fecal leak and peritonitis. We describe a unique case of emergency percutaneous cecostomy for functional obstruction because of severe neutropenic colitis of the sigmoid colon. The cecum was fixed with four T-fasteners designed for gastropexy during radiological gastrostomy, and a large gastrostomy feeding tube was inserted. Drainage of fecal matter was difficult and intermittent; however, it allowed sufficient decompression of the bowel to prevent perforation until the neutropenic colitis resolved. In the absence of dedicated drainage systems for the bowel, standard gastrostomy kits can be used as an emergency measure in life-threatening large bowel obstructions if surgical options or stenting are inappropriate.
GE - Portuguese Journal of Gastroenterology, 2019
Background and Study Aim: Superficial gastrointestinal (GI) neoplasms can be treated with endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD). These techniques are widely used in Eastern countries; however, its use in the West is limited. The aim of this study was to evaluate the current implementation of ESD in Western countries. Methods: Western endoscopists (n = 279) who published papers related to EMR/ESD between 2005 and 2017 were asked to complete an online survey from December 2017 to February 2018. Results: A total of 58 endoscopists (21%) completed the survey. Thirty performed ESD in the esophagus (52%), 45 in the stomach (78%), 36 in the colorectum (62%), and 6 in the duodenum (10%). The median total number of lesions ever treated per endoscopist was 190, with a median number per endoscopist in 2016 of 41 (7 [IQR 1-21], 6 [IQR 4-16], and 28 [5-63] in the esophagus, in the stomach, and in the colon and rectum, respectively). En bloc resection rates were 97% in the esophagus, 95% in the stomach, and 84% in the colorectum. Complete resection (R0) was achieved in 88, 91, and 81%, respectively. Curative rates were 69, 70, and 67%, respectively. Major complications (perforation or delayed bleeding) occurred more often in colorectal ESD (12 vs. 6% in the esophagus and 7% in the stomach). In the upper GI tract, the majority of resected lesions were intramucosal adenocarcinoma (59% in the esophagus; 47% in the stomach), while in the colorectum the majority were adenomas (59%). Conclusion: ESD seems to be performed by a large number of centers and endoscopists. Our results suggest that ESD is being successfully implemented in Western countries, achieving a good rate of efficacy and safety according to European guidelines.