Percutaneous endoscopic caecostomy for severe constipation in adults: feasibility, durability, functional and quality of life results at 1 year follow-up Emilie Duchalais • Guillaume Meurette • Surendra K. Mantoo • Marc Le Rhun • Stanislas Bruley des Varannes • Paul-Antoine Lehur • Emmanuel Coron Received: 6 November 2013 / Accepted: 25 June 2014 Ó Springer Science+Business Media New York 2014 Abstract Background The percutaneous endoscopic ceacostomy (PEC) for antegrade colonic enemas (ACE) has recently been proposed as a less invasive alternative to the Malone procedure in chronic constipated patients. Although the feasibility and safety of this innovative approach has been demonstrated, its functional results remain unknown. The aim of this study was to evaluate constipation symptoms and quality of life 1 year after the PEC placement. Method From Oct 2007 to Apr 2011, 21 severely con- stipated patients who required ACE were prospectively included. They underwent endoscopic placement of Chait caecostomy catheter (Cook Medical). Patients completed standardized questionnaires to assess constipation (KESS) and quality of life (GIQLI) scores pre PEC placement and at 1 year. Adverse events and caecostomy use data were also documented. Results The caecostomy catheter was successfully placed in 19 patients. Complications were all minor, including chronic wound pain (n = 9), serous leakage (n = 7), superficial wound infection (n = 2) and accidental catheter removal (n = 2). Chronic wound pain led to definitive catheter removal in 5 (26 %) patients. One patient died from unrelated cause before the end of the follow-up. At 1 year, 11 (61 %) of the alive patients still performed ACE. During the period of ACE administration, 14 (74 %) patients suspended use of laxatives and retrograde irriga- tions. Constipation and quality of life scores were available in 15 patients. Median KESS score improved from 25 (12–39) before PEC to 17 (6–34) 1 year after PEC (p \ 0.05). Median GIQLI score increased from 69 (25–108) to 95 (48–119) (p \ 0.05). Conclusion PEC placement achieves satisfying func- tional and quality of life results, and allows approximately 3/4 of patients to suspend laxatives and retrograde enemas. Nevertheless, 1/4 of the patients ask for the PEC removal because of chronic wound pain. In order to improve long- term durability of the device, a better prevention of pain is required. Keywords Percutaneous endoscopic caecostomy Á Antegrade colonic enema Á Chronic constipation Á Quality of life Chronic constipation is a condition of variable severity. Conservative managements including dietary adjustments, laxatives and retrograde enemas achieve symptom relief in majority of patients [1, 2]. However, in 7 % of chronically constipated patients, medical treatment is inadequate or badly tolerated [3]. These patients refractory to medical treatment have persistent symptoms of severe abdominal discomfort and overflow anal incontinence leading to a significant negative impact on the patient’s quality of life [4, 5]. There are multiple but no satisfactory surgical inter- ventions proposed for management of refractory constipa- tion. Commonly available procedures like total colectomy E. Duchalais Á G. Meurette Á M. Le Rhun Á S. B. d. Varannes Á P.-A. Lehur Á E. Coron Institute of Digestive Disease, University Hospital of Nantes, 44093 Nantes, France E. Duchalais (&) Á G. Meurette Á S. K. Mantoo Á P.-A. Lehur Clinique de chirurgie digestive et endocrinienne, University Hospital of Nantes, 44093 Nantes, France e-mail: emilie.duchalais@gmail.com M. Le Rhun Á S. B. d. Varannes Á E. Coron Department of Gastroenterology and Hepatology, University Hospital of Nantes, 44093 Nantes, France 123 Surg Endosc DOI 10.1007/s00464-014-3709-1 and Other Interventional Techniques