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Published on: January 7, 2019
Prospective switch study comparing two irrigation systems for transanal irrigation in children
K Van Renterghem1, M Sladkov2, L Matthyssens1
1Ghent University Hospital, Pediatric Surgery, Ghent, Belgium.
Insights
Peristeen® significantly improved continence and independence in children compared to Colotip® for transanal irrigation (TAI). However, some patients experienced issues with Peristeen®, suggesting careful patient selection is needed.
Area of Science:
- Pediatric Gastroenterology
- Urology
- Medical Device Technology
Background:
- Transanal irrigation (TAI) is a treatment for pediatric constipation and incontinence.
- Two TAI systems, Colotip® and Peristeen®, are available in Belgium.
- Colotip® is cheaper but not specifically designed for TAI.
Purpose of the Study:
- To compare the efficacy and patient experience of Colotip® versus Peristeen® for TAI in children.
- To evaluate outcomes such as fecal continence, self-reliance, pain, and patient satisfaction.
Main Methods:
- A patient-control switch study was conducted.
- Children using Colotip® for TAI were invited to participate.
- Data collected included Visual Analogue Scale (VAS) ratings and a 2-week diary assessing continence, self-reliance, time on toilet, pain, stool consistency, and irrigation parameters.
Main Results:
- Out of 18 participants, 11 completed the study with Peristeen®.
- Peristeen® showed significant improvements in pseudo-continence (p=0.015) and independence (p=0.01).
- Patient satisfaction, measured by VAS score, was also significantly higher with Peristeen® (p=0.007).
Conclusions:
- Peristeen® offers superior pseudo-continence and independence in pediatric TAI.
- Satisfaction with Colotip® led 30% of patients to refuse participation.
- Rectal balloon loss in spina bifida patients using Peristeen® highlights the need for further research on patient selection and potential use of a test-catheter.
Background And Study Aims:
Transanal irrigation (TAI) is used in children to treat constipation and incontinence. Belgium has 2 systems available: Colotip® (cheaper, however not designed for TAI) or Peristeen®.
Patients And Methods:
This patient-control switch study is the first to compare 2 TAI systems. Children regularly using Colotip® for TAI were asked to participate, after consent, a visual analogue scale (VAS) rating the system and a 2-week diary (fecal continence, self-reliance, time spent on the toilet, pain, Bristol stool scale, irrigation volume and frequency of enema) were completed. Non-parametric statistics were used.
Results:
Out of 26 children using Colotip®, 18 (69%) children participated and 5 refused (fear n=1, satisfaction Colotip® system n=7). Of these 18 children (interquartile range: 3-18 years, median 12.5 years, 9 girls) 5 patients stopped Peristeen® (pain n=1, fear n=1 and balloon loss n=3) and 2 were lost from follow up. Dropouts and included patients showed no statistical difference. In the 11 remaining patients, pseudo-continence (p 0.015), independence (p 0.01) and VAS score (p 0.007) were significantly better with Peristeen®, no difference was found in time spent on the toilet (p 0.288) and presence of pain (p 0.785).
Conclusions:
In children Peristeen® offered significantly higher pseudo-continence and independency. 30% refused participation because of satisfaction with the Colotip® and 30% spina bifida patients reported rectal balloon loss due to sphincter hypotony. To diminish Peristeen® failure, a test-catheter could be of value. Considering Colotip® satisfaction, both systems should be available. Patient selection for Peristeen® needs further research.
