Introducer method of percutaneous endoscopic cecostomy and antegrade continence enema by use of the Chait Trapdoor cecostomy catheter in patients with adult neurogenic bowel

Abstract

Background: Previous reports on percutaneous endoscopic cecostomy (PEC) for the delivery of antegrade continence enema (ACE) in adults have been presented in the form of case reports. Heretofore the tubes used in the pull method of PEC have been thick bolster catheters. The author performed PEC by using the introducer method (IM) with 10 F Chait Trapdoor cecostomy catheters (CTCC) in adult cases.

Objective: Report author experience with a new method of PEC in adults.

Design: Case series.

Setting: Single institution in Japan.

Patients: Five patients with bowel obstruction and 15 patients with chronic severe constipation.

Interventions: The interventions were the pull method or IM of PEC and drainage or ACE. In 5 cases, PEC was performed by the pull method with the use of an 18 F to 24 F bolster catheter for decompression of dilated intestine. In 15 patients with chronic constipation, PEC was performed with the IM method using a balloon catheter (11 F or 15 F) and CTCC. ACE was performed every other day.

Results: PEC was successful and effective (decompression and evacuation) in all patients. In patients with IM of PEC, 5 patients were placed with a 15 F balloon catheter and 10 patients were placed with an 11 F balloon catheter. Immediate bleeding occurred in 1 case. Balloon rupture occurred during the first month or on average at the 1 month period. Nine of 10 patients who had the 11 F catheters were changed to CTCC. The advantages of CTCC were prevention of accidental balloon rupture, decreased leakage and granulation tissue, and ease of exchange compared with bolster catheter.

Limitations: Retrospective, single-institution.

Conclusions: PEC with IM is a safe and useful method. CTCC is advantageous on a long-term basis for ACE.