Colonic manometry and contrast enema findings in children with ineffective antegrade continence enema therapy

Antegrade continence enema (ACE) is an effective therapy for many children with medically refractory constipation. However, some patients lose response over time. This study aims to describe and explore physiological and anatomic correlates of ACE failure in children.

Electronic medical records of children who were no longer responding to ACE and were seen in our collaborative neurogastroenterology and colorectal surgery clinic over 7 years were reviewed. Demographic and clinical data, as well as contrast enema (CE) and colonic manometry (CM) findings, were examined in all subjects. Data was compared among the cohort who had a normal versus abnormal CM study, and between those who had a duration of ACE use<36 months versus ≥36 months.

Over a 7-year period, 22 children (median age 11 years, IQR 8.1-14.4; 54.5% male) with ineffective ACE therapy were included, of whom 41% had abnormal colonic manometry. Patients with normal CM demonstrated significantly greater total and bisacodyl-induced high-amplitude propagated contractions and higher right colonic contractile amplitude compared with those with abnormal manometry (all p ≤ 0.01), but colonic caliber did not differ and did not correlate with manometry findings (right: r = 0.04, p = 0.87; left: r = -0.12, p = 0.57). Patients with ACE duration ≥36 months had a higher prevalence of right colonic dilation (83.3% vs 30%, p = 0.027) and larger maximal right colonic diameter (p = 0.02). Within this group, right colonic contractile amplitude was lower than left colonic contractile amplitude (p = 0.02).

Prolonged ACE use (≥36 months) demonstrated a higher prevalence of right colonic dilation and differences in selected colonic manometry parameters compared with those with shorter ACE duration.