Systematic Review of Reported Outcomes for Antegrade Continence Enema in Patients With Anorectal Malformation and...

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Research Methodology

Background:

• Antegrade continence enema (ACE) is a surgical procedure used to manage fecal incontinence in patients with anorectal malformations (ARM) and Hirschsprung disease (HD).
• Standardized reporting of outcomes and study characteristics is crucial for evaluating treatment efficacy and guiding clinical practice.

Purpose of the Study:

• To systematically identify and analyze the reported parameters and study characteristics in the existing literature on ACE procedures for patients with ARM and HD.
• To assess the heterogeneity in outcome reporting and the utilization of patient-centered outcome measures in ACE studies.

Main Methods:

• A comprehensive literature search was conducted following PRISMA guidelines across multiple databases (Ovid MEDLINE, Cochrane Central, Embase, CINAHL).
• Search terms included "anorectal malformation" or "Hirschsprung disease" combined with relevant ACE procedure terms.
• Data extraction and screening were performed independently by two reviewers, with specific inclusion and exclusion criteria applied.

Main Results:

• Out of 257 identified papers, 48 met the inclusion criteria, predominantly retrospective studies (76%).
• A high degree of heterogeneity was observed, with 301 different parameters identified, but only 9% reported in over 50% of publications.
• Commonly reported baseline parameters included sex and age at surgery, while outcome parameters focused on enema success, complication rates, and revision surgery. Patient-reported outcome measures (PROMs) and quality of life assessments were infrequently utilized (25% and 6%, respectively).

Conclusions:

• There is substantial heterogeneity in the reporting of outcomes for antegrade continence enema (ACE) in patients with ARM and HD.
• The current literature rarely employs validated questionnaires or patient-reported outcome measures (PROMs), limiting comprehensive outcome assessment.
• Standardization of reporting parameters and increased use of PROMs are recommended to improve the quality and comparability of research in this field.