Percutaneous Endoscopic Caecostomy – An endoscopic ACE procedure

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Introduction

Percutaneous endoscopic caecostomy (PEC) is an endoscopic modification of the antegrade continence enema (ACE) technique originally described by Malone in 1990. An ACE has become a popular way to treat refractory incontinence & constipation. Malone created an appendicostomy into the caecum via an open surgical procedure to give access to the colon for washout without using the rectum. The PEC is created using the same principles as a Percutaneous Endoscopic Gastrostomy(PEG) insertion to place a device into the caecum that will allow colonic washout and achieve continence.

Aims

We present our experience with PEC procedure to show it is a safe technique that could be carried out by endoscopists.

Methods

We undertook a retrospective review of PEC procedures carried out in RBHSC between 1999-2015. All procedures done by the same operator.

Results

Sixteen cases were identified (12 boys & 4 girls), age range 3 -14 years at placement. Underlying diagnosis was idiopathic constipation in 12, Anorectal malformation in 2, Intestinal neuronal dysplasia in 1 & Hirschsprungs in 1. Complications included one granuloma around caecostomy site and one failed colonoscopy converted to an open procedure. Eleven of the sixteen children went on to achieve improved bowel management. Four failed treatment for constipation with the PEC & went on to have stoma formation. One child died before use of the PEC.

Conclusion

PEC is a safe procedure with no significant endoscopy related complications. It negates having a formal open operation that can therefore is another skill for an endoscopist.