Variation in Practice Surrounding Antegrade Colonic Enema Channel Placement

Eustina G Kwon; Jenny Kreiss; Lauren Nicassio; Kelly Austin; Jeffrey R Avansino; Andrea Badillo; Casey M Calkins; Rachel C Crady; Belinda Dickie; Megan M Durham; Jason Frischer; Megan K Fuller; K Elizabeth Speck; Ron W Reeder; Rebecca Rentea; Michael D Rollins; Payam Saadai; Richard J Wood; Kathleen D van Leeuwen; Caitlin A Smith; Samuel E Rice-Townsend

doi:10.1016/j.jpedsurg.2024.04.009

Variation in Practice Surrounding Antegrade Colonic Enema Channel Placement

J Pediatr Surg. 2024 Apr 19:S0022-3468(24)00260-4. doi: 10.1016/j.jpedsurg.2024.04.009. Online ahead of print.

Authors

Eustina G Kwon¹, Jenny Kreiss², Lauren Nicassio², Kelly Austin³, Jeffrey R Avansino², Andrea Badillo⁴, Casey M Calkins⁵, Rachel C Crady⁶, Belinda Dickie⁷, Megan M Durham⁸, Jason Frischer⁹, Megan K Fuller¹⁰, K Elizabeth Speck¹¹, Ron W Reeder⁶, Rebecca Rentea¹², Michael D Rollins¹³, Payam Saadai¹⁴, Richard J Wood¹⁵, Kathleen D van Leeuwen¹⁶, Caitlin A Smith², Samuel E Rice-Townsend²

Affiliations

¹ Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA. Electronic address: ekwon@pennstatehealth.psu.edu.
² Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
³ Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, George Washington University, Washington, DC, USA.
⁵ Department of Surgery, Wisconsin Children's Hospital, Milwaukee, WI, USA.
⁶ Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
⁷ Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
⁸ Department of Surgery, Children's Hospital of Atlanta, Atlanta, GA, USA.
⁹ Department of Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA.
¹⁰ Department of Surgery, Boys Town Research Hospital-Children's of Omaha, Boys Town, NE, USA.
¹¹ Division of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
¹² Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA.
¹³ Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
¹⁴ Department of Surgery, University of California Davis, Davis, CA, USA.
¹⁵ Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
¹⁶ Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.

PMID: 38760309
DOI: 10.1016/j.jpedsurg.2024.04.009

Abstract

Purpose: Antegrade colonic enemas (ACE) can be an effective management option for defecation disorders and improve quality of life. Best practice regarding channel placement is unclear and variation may exist around preferred initial type of channel, age at placement, and underlying diagnoses. We aimed to describe practice patterns and patient characteristics around ACE channel placement.

Methods: We conducted a multicenter retrospective study of children with an ACE channel cared for at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) from 2017 to 2022. Kruskal-Wallis test was utilized to test the age at surgery by site with significance level of 0.05.

Results: 500 patients with ACE channel were included. 293 (58.6%) patients had their ACE procedure at a PCPLC center. The median age at surgery was 7.6 [IQR 5.3-11.0] years for the overall cohort and 8.1 [IQR 5.3-11.5] years for placement at PCPLC centers. For PCPLC centers, median age at placement varied significantly across centers (p = 0.009). 371 (74.2%) patients received Malone appendicostomy, 116 (23.2%) received cecostomy, and 13 (2.6%) received Neo-Malone appendicostomy. Median age of patients by channel type was 7.7 [IQR 5.3-11.0], 7.5 [IQR 5.7-11.0], and 9.8 [IQR 4.2-11.6] years, respectively. The most common indication for cecostomy was idiopathic/refractory constipation (52.6%), whereas anorectal malformation was the most common indication for Malone (47.2%) and Neo-Malone (61.5%). Among ACE channels placed at PCPLC centers, there was variation across institutions in preferred initial channel type. The 4 highest volume centers favored Malone appendicostomy over cecostomy.

Conclusion: There is variation in practice of ACE channel placement. At specialty pediatric colorectal centers, age at time of placement and type of channel placed varied across institutions. Further work is needed to better characterize diagnosis- and age-focused patient centered outcomes to clarify recommendations for our patients who benefit from these procedures.

Type of study: Retrospective comparative study.

Level of evidence: Level III.

Keywords: Anorectal malformation; Antegrade colonic enema; Hirschsprung disease.

Published by Elsevier Inc.