Introduction Antegrade continence enema (ACE) is a proximal colonic stoma that allows antegrade lavage of the colon for the treatment of faecal incontinence (FI) and functional constipation (FC). Since its first description,¹it has become widely accepted in the paediatric population. However, its role in the treatment of these conditions in adults has not been established. This review aims to evaluate the clinical response and complications of ACE in the adult population.

Method The Medline and EMBASE databases were searched using the following criteria: (antegrade AND (continent OR continence OR colonic) AND enema).ti, ab [Limit to: Humans and (Age Groups All Adult 19 plus years)]. The Cochrane Central Register of Controlled trials (CENTRAL) was searched using the term “antegrade continence enema” in the Title, Abstract or Keywords section. Two independent reviewers screened abstracts and selected studies for inclusion. Only studies with participants aged 16 years and above were selected and quality of study was assessed using the MINORS score.²

Results In all, 381 articles were retrieved, of which, 90 were duplicates. After review of the 291 abstracts, 32 full text publications were scrutinised and 18 were found to meet the inclusion criteria. Four studies were from the same institution, hence, 15 studies describing outcomes in 384 patients were included in the final analysis. All reports were observational cross sectional studies, four were prospective. Six studies included patients with either FC or FI, four with FI alone and five with FC alone. There was considerable heterogeneity within and across studies, hence, meta-analysis was not possible. Most studies were of poor quality as reflected in the low MINORS score.

The number of participants still using ACE ranged from 47% to 100% over a follow up period of 6 to 55 months. Eleven studies reported achievement of full continence in 33% to 100% patients. Four studies described functional outcomes and seven studies reported a wide range of patient satisfaction. The rate of stoma stenosis varied from 8% to 50% and the rate of end stoma varied from 0–24%.

Conclusion ACE has been reported as an acceptable treatment of FI or FC in adults across several analyses. There is wide variation regarding outcome measures. Larger prospective studies are required to assess the role of ACE in the adult population.

Disclosure of interest None Declared.

References

1. Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema. Lancet 1990;336:1217–8

2. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73:712–6