Percutaneous endoscopic colostomy of the left side of the colon

Abstract

Background: Percutaneous endoscopic colostomy (PEC) on the left side of the colon is a minimally invasive endoscopic technique, increasingly used to treat lower-GI conditions.

Objective: To evaluate the efficacy and safety of a PEC tube insertion at a single unit.

Design: Retrospective data collection.

Setting: District general and teaching hospital in the United Kingdom.

Patients: Data collected from patients with lower-GI disorders who had a PEC tube inserted.

Interventions: Data collection.

Main outcome measurements: Incidence of complications and patient outcome.

Results: Between 2001 and 2005, 31 patients presented for a PEC. Insertion was possible in 27 patients. Indications included functional constipation (n=8), recurrent sigmoid volvulus (n=8), colonic pseudo-obstruction (n=5), and neurologic constipation (n=6). In 22 patients (81%), symptoms were markedly improved after insertion. Sigmoid volvulus did not recur with a PEC tube in place. The mean (standard error of the mean) duration with tubes in situ was 9.5+/-1.6 months. Only 2 patients still had a PEC tube in situ. A total of 77% of patients had episodes of infection. Infective episodes led to tube removal in 44% of the total group. Other complications included buried internal bolster, fecal leakage, and pain. Mortality was high (26%), with 7 deaths: 5 from unrelated causes and 2 deaths from fecal peritonitis.

Limitations: This was a retrospective study. A prospective study in our unit is unlikely because of these results.

Conclusions: Symptoms were effectively controlled by a PEC tube insertion, and recurrent sigmoid volvulus was prevented. Recurrent complications caused significant morbidity. Infection necessitated tube removal in the majority of patients. Fatal fecal peritonitis occurred in 2 patients. Indiscriminate use of a PEC in the left side of the colon is not recommended. A PEC should only be considered in carefully selected cases.