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Percutaneous cecostomy: 25-year two institution experience

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Abstract

Background

Reports of technical success, adverse events, and long-term outcome of percutaneous cecostomy in children are limited.

Objective

To characterize technical success, 30-day severe adverse events, and long-term outcome of percutaneous cecostomy at two centers.

Materials and methods

A retrospective review of hospital course and long-term follow-up (through May 2022) of percutaneous cecostomy tubes placed May 1997 to August 2011 at two children’s hospitals was used. Outcomes assessed included technical success (defined as successful tube placement into the colon allowing antegrade colonic enemas), length of stay, 30-day severe adverse events, surgery consults, surgical repair, VP shunt infection, ongoing flushes, tube removal, duration between maintenance tube exchanges, and deaths.

Results

A total of 215 procedures were performed in 208 patients (90 institution A, 125 institution B). Tubes were placed for neurogenic bowel (72.1%, n = 155) and functional constipation (27.9%, n = 60). Technical success was 98.1% (211/215) and did not differ between centers (p = 0.74). Surgical repair was required for bowel leakage in 5.1% (11/215) and VP shunt infection was managed in 2.1% (2/95). Compared to functional constipation, patients with neurogenic bowel had higher % tube remaining (65.3% [96/147] versus 25.9% [15/58], p < 0.001) and higher ongoing flushes at follow-up (42.2% [62/147] versus 12.1% [7/58], p < 0.001). Tube removal for dissatisfaction occurred in 15.6% [32/205] and did not differ between groups (p = 0.98). Eight deaths due to co-morbidity occurred after a median of 7.4 years (IQR 9.3) of tube access.

Conclusion

Percutaneous cecostomy is technically successful in the vast majority of patients and provided durable access in most. Bowel leakage and VP shunt infection are uncommon, severe adverse events.

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Funding

A Clinical and Translational Science Award to the University of Arkansas for Medical Sciences (UL1TR000039) partially supported statistical analysis of this study.

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Authors and Affiliations

  1. Department of Radiology, Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, Slot 105, 1 Children’s Way, Little Rock, 72202, AR, USA

    Charles A. James, Luke T. James, Hanna K. Jensen & Mary B. Moore

  2. Department of Radiology, Nationwide Children’s Hospital, Ohio State University, Columbus, OH, USA

    Mark J. Hogan, Ryan P. Seay & Leah E. Braswell

  3. Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Nicholas A. Kaukis

Authors
  1. Charles A. James
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  2. Mark J. Hogan
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  3. Ryan P. Seay
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  4. Luke T. James
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  5. Hanna K. Jensen
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  6. Nicholas A. Kaukis
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  7. Mary B. Moore
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  8. Leah E. Braswell
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Contributions

CAJ, MBM, and LEB were the operators at institution A and performed all inpatient management of these patients. MJH was the sole operator at institution B and assisted the primary gastroenterology service on inpatient management of these patients. RPS and LTJ performed database management and data collection. NAK conducted the statistical analysis. CAJ and HKJ took the lead in drafting the manuscript as well as the revisions requested. All authors discussed the results and reviewed and edited the final manuscript.

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Correspondence to Charles A. James.

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James, C.A., Hogan, M.J., Seay, R.P. et al. Percutaneous cecostomy: 25-year two institution experience. Pediatr Radiol (2024). https://doi.org/10.1007/s00247-024-05936-2

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  • DOI: https://doi.org/10.1007/s00247-024-05936-2

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