Riad Rahhal, MD, MS, on Re-Establishing Lost Cecostomy Access in Children
Cecostomy tubes are commonly used in children with spinal defects and anorectal malformations. However, cecostomy access is sometimes lost in this population. Therefore, a research team aimed to describe the safety and effectiveness of a colonoscopy-assisted approach to re-establish lost cecostomy access in children.
To find out more about this research and its findings, Gastroenterology Consultant reached out to lead author Riad Rahhal, MD, MS, who is a clinical professor in the Division of Pediatric Gastroenterology, fellowship director of the Department of Pediatrics, vice chair for education in the Stead Family Department of Pediatrics at UI Stead Family Children’s Hospital and University of Iowa Health Care in Iowa City, Iowa.
GASTRO CON: What is the most appropriate and efficient way to change cecostomy tubes?
Riad Rahhal: Cecostomy tube replacement is usually performed every 6 to 12 months via percutaneous approach with or without fluoroscopic assistance. This approach is successful in more than 95% of cases. Methods for exchange include removing the existing cecostomy tube over a wire with advancement of a new tube into the cecum. This is an outpatient procedure that can be performed with or without sedation.
GASTRO CON: How did your study highlight the role of colonoscopy assistance to salvage lost cecostomy access in children who fail percutaneous replacement?
RR: In patients who failed the percutaneous exchange approach (about 1% of cases), colonoscopy assistance proved to be highly successful in salvaging lost cecostomy access. The role of the endoscopist was to provide transillumination and endoscopic visualization during cecostomy tube placement with the option of more-active intervention by pulling the tube adequately into the cecal lumen if needed.
GASTRO CON: What prompted you to conduct the study?
RR: When encountering patients with failed percutaneous cecostomy tube replacement, management options become very limited to either abandoning cecostomy access or proceeding to surgery to re-establish access. Neither of these are optimal, so the colonoscopy-assisted approach was thought to be both promising and less invasive. One of the study aims was to make providers and patients aware of this added option to be considered in their decision making.
GASTRO CON: What are the most important findings from your study?
RR: Colonoscopy with cecal transillumination can be a valuable and successful approach and offers a less invasive alternative to surgery to re-establish cecal access when percutaneous attempts to replace a cecostomy tube fail.
GASTRO CON: What are the clinical implications of your study for pediatric gastroenterologists?
RR: In many centers, cecostomy tube management is limited to specific services within surgery and/or interventional radiology with very high dependence on percutaneous approaches for exchanges. Although a clear majority of percutaneous exchanges are successful, a small subset will not be. Pediatric gastroenterologists can be active participants within multidisciplinary teams that manage cecostomy tubes with a specific role in addressing difficult exchanges to help avoid invasive and likely more costly alternatives.
GASTRO CON: What are the next steps of your research?
RR: We are interested in objectively assessing potential cost savings and reductions in anesthesia time and length of hospital stay when comparing the colonoscopy assisted and surgical approaches in restoring lost cecostomy access. We anticipate this would provide further evidence in support of using colonoscopy in the algorithm for cecostomy tube management.
Reference:
- Dike C, Rahhal R. Successful colonoscopy-assisted cecostomy tube replacement to salvage lost cecostomy tract access in children. J Pediatr Gastroenterol Nutr. 2019;69(3):e60-e64. https://doi.org/10.1097/mpg.0000000000002389.