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Use of percutaneous endoscopic colostomy (PEC) to treat sigmoid volvulus: a systematic review
Lucinda Frank1, Alex Moran2, Ceri Beaton1
1Department of Colorectal Surgery, North Devon District Hospital, Barnstaple.
Insights
Percutaneous endoscopic colostomy (PEC) is a viable option for recurrent sigmoid volvulus in high-risk patients. Despite a 21% morbidity and 5% mortality risk, PEC outcomes are favorable compared to surgery.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Recurrent sigmoid volvulus poses a significant risk, particularly for patients unsuitable for surgery.
- Percutaneous endoscopic colostomy (PEC) emerged as a less invasive alternative.
- NICE guidelines from 2006 supported PEC, necessitating an updated review.
Purpose of the Study:
- To evaluate the current validity of NICE guidelines regarding PEC for recurrent sigmoid volvulus.
- To assess the safety and efficacy of PEC in contemporary practice.
Main Methods:
- Systematic literature search across PubMed, Web of Science, and Embase.
- Utilized exploded search terms: "Percutaneous Endoscopic Colostomy" and "Sigmoid Volvulus".
- Inclusion criteria applied to 5 observational studies and 5 case reports.
Main Results:
- Data from 56 patients treated with PEC for recurrent sigmoid volvulus.
- Major complications occurred in 5 patients (peritonitis, self-removal, death); minor complications in 9 (mostly site infections).
- Recurrence with in-situ PEC occurred in 4 patients; overall morbidity 21%, mortality 5%.
Conclusions:
- PEC demonstrates a favorable risk profile compared to surgical intervention for recurrent sigmoid volvulus.
- The findings support the continued use of PEC for frail and elderly patients with recurrent sigmoid volvulus.
- Contemporary literature validates the use of PEC as an alternative management strategy.
Background And Aim:
Percutaneous endoscopic colostomy provides an alternative management option for patients with recurrent sigmoid volvulus who are considered too high risk to undergo surgery. We reviewed the literature to assess whether the National Institute for Health and Clinical Excellence guidelines published in 2006 supporting the use of percutaneous endoscopic colostomy are still valid.
Methods:
A systematic literature search was conducted using PubMed, Web of Science, and Embase. The exploded search terms "Percutaneous Endoscopic Colostomy" and "Sigmoid Volvulus" were used. Librarian support was used to ensure the maximum number of relevant articles were returned. Identified abstracts were then analyzed and included if they met the inclusion criteria.
Results:
Five observational studies and 5 case reports were identified that met the inclusion criteria. They provided data on 56 patients with recurrent sigmoid volvulus treated with percutaneous endoscopic colostomy placement. Sixteen of the 56 patients were treated with a single percutaneous endoscopic colostomy (PEC) tube while 38 patients were treated with 2 PEC tubes. For 2 patients the details of the procedure were unknown. Five patients developed major complications following the procedure: 1 patient developed peritonitis after 4 days, due to fecal contamination secondary to tube migration and 2 patients with cognitive impairment pulled their PEC tubes out. Two other patients died following PEC insertion. Nine patients developed minor complications following the procedure. The most commonly reported minor complication was infection at the PEC site. Four of 56 patients developed a recurrent sigmoid volvulus with a PEC tube in situ.
Conclusion:
Although in these case series there is a 21 % risk of morbidity and 5 % risk of mortality from the use of a PEC, this is favorable compared to the mortality risk of 6.6 % to 44 % reported with operative intervention. This review of contemporary literature therefore supports the use of PEC in frail and elderly patients.
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