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Comparison of colonoscopic versus fluoroscopic colonic manometry catheter placement in children
Anna E Leone1,2, Julia M J van der Zande1,3, Shruthi Srinivas4
1Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Colonoscopic placement of colonic manometry catheters is superior to fluoroscopic placement for studying the extent of the colon in children. This method is recommended for refractory constipation due to better reach and no increased risk of displacement.
Area of Science:
- Pediatric Gastroenterology
- Medical Device Technology
- Diagnostic Procedures
Background:
- Colonic manometry is crucial for diagnosing motility disorders in children.
- Catheter placement for colonic manometry can be achieved via colonoscopy or fluoroscopy.
- Choosing the optimal placement technique impacts study efficacy and patient outcomes.
Purpose of the Study:
- To compare the outcomes of colonoscopic versus fluoroscopic catheter placement for colonic manometry in pediatric patients.
- To evaluate the extent of colonic study achieved and the incidence of catheter displacement for each method.
Main Methods:
- A retrospective review of pediatric colonic manometry studies conducted between May 2015 and May 2022.
- Inclusion criteria encompassed all studies with per-rectal catheter placement.
- Data collected included patient demographics, clinical history, and catheter placement details (technique, position, displacement).
Main Results:
- Colonoscopic placement (n=274) resulted in significantly greater colonic reach (ascending colon) compared to fluoroscopic placement (n=208) (49% vs. 23%, p<0.001).
- Children undergoing colonoscopic placement were older and more frequently diagnosed with functional constipation.
- Fluoroscopic placement was more common in children with complex conditions like intestinal pseudo-obstruction or ostomies.
- No significant differences in catheter displacement frequency or extent were observed between the two methods.
Conclusions:
- Colonoscopic catheter placement offers superior colonic coverage during manometry studies in children.
- The technique demonstrates no increased risk of catheter displacement compared to fluoroscopy.
- Colonoscopic placement is recommended as the preferred method for pediatric colonic manometry, particularly in cases of refractory constipation.
Objectives:
Colonic manometry catheter placement can be performed by colonoscopy or fluoroscopy. Our objective was to compare outcomes of colonoscopic to fluoroscopic catheter placement in children based on the extent of colon study and the likelihood of catheter displacement.
Methods:
Colonic manometry studies performed between May 2015 and May 2022 were reviewed. All studies with catheter placement per rectum were included. Data on patient demographics, medical and surgical history, and information on catheter placement (type of catheter, placement technique, position, and displacement) were recorded.
Results:
We reviewed 555 studies and included 482 studies performed on 453 children (51% female, median age 10 years, interquartile range: 7-14 years). The catheter was placed during colonoscopy in 274 studies and using fluoroscopy in 208 studies. Children with colonoscopic placement were significantly older (median age 11 vs. 8 years, p < 0.001), more commonly male (55% vs. 41%, p = 0.003), and more commonly had functional constipation (85% vs. 69%, p < 0.001). Children with fluoroscopic placement more often had pediatric intestinal pseudo-obstruction (10% vs. 1%, p < 0.001), a diverting ostomy (21% vs. 7%, p < 0.001), and a cecostomy (10% vs. 4%, p = 0.023). A successful catheter placement (reaching ascending colon) was significantly more common using colonoscopy (49% vs. 23%, p < 0.001). There were no differences in frequency or extent of catheter displacement between colonoscopic and fluoroscopic placement.
Conclusions:
Colonoscopic placement was superior to fluoroscopic placement in terms of the extent of the colon studied with no differences in frequency of catheter displacement. Colonoscopic placement should be the preferred method in most children with refractory constipation.
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