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Successful Colonoscopy assisted Cecostomy Tube Replacement to Salvage Lost Cecostomy Tract Access in Children

Dike, Chinenye; Rahhal, Riad

Journal of Pediatric Gastroenterology and Nutrition: May 6, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002389
Original Article: Gastroenterology: PDF Only
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Objectives: Cecostomy tubes are commonly used for antegrade enema delivery in children with spinal defects and anorectal malformations to help address chronic constipation and fecal incontinence. Once surgically or radiologically placed, cecostomy tubes require changes by a percutaneous approach, which may be unsuccessful requiring repeat laparoscopy or open surgery to re-establish the cecostomy tract. The role of colonoscopy assistance to salvage lost cecostomy access in children who fail percutaneous replacement is not well described. The primary aim was to describe the safety and effectiveness of a colonoscopy-assisted approach to re-establish lost cecostomy access in children.

Methods: This was a retrospective cohort study of the methods, success and complication rates associated with colonoscopy assisted cecostomy tube replacement in children between 2000 and 2017 at a pediatric tertiary care center.

Results: Ninety-five patients with 841 attempted procedures were included with only 1% of procedures requiring endoscopic assistance. These included 7 colonoscopy-assisted cecostomy tube replacement procedures in 6 patients (median age 9.2 years, median weight 26.3 kg, 33% girls). The most common reason for using colonoscopy assistance was a failed percutaneous approach. The colonoscopy-assisted approach was successful in all cases without documented complications.

Conclusions: Colonoscopy-assisted cecostomy tube replacement is safe and highly successful in re-establishing lost cecostomy access in children after failed attempts with percutaneous or fluoroscopic-guided approaches.

Division of Pediatric Gastroenterology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA.

Address correspondence and reprint requests to Riad Rahhal, MD, MS, Division of Pediatric Gastroenterology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, BT1120-A, Iowa City, IA 52242 (e-mail: riad-rahhal@uiowa.edu).

Received 21 November, 2018

Accepted 18 April, 2019

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,