PTH-007 Percutaneous endoscopic colostomy prevents repeated hospital admission in colonic pseudo-obstruction with or without sigmoid volvulus

Abstract

Introduction Percutaneous endoscopic colostomy (PEC) for venting and fixation is a treatment option in patients with severe physical and/or mental disability and chronic intestinal pseudo-obstruction/megacolon, who need repeated hospital admissions with acute episodes of pseudo-obstruction with or without sigmoid volvulus. These patients are normally treated by repeated endoscopic decompression but are unfit for major surgery. We present our series of 38 such patients who underwent PEC with a mean follow-up of 10.6 (range 1–79) months. Methods Thirty-eight patients underwent PEC. Mean age was 72.4 (range 40–93) years. One or two PEC tubes were placed in the dilated sigmoid colon for venting and fixation. The tubes were subsequently changed to low-profile ballooned devices which were left in place indefinitely. Patients or carers vented the tubes as necessary to keep the colon decompressed. Data were collected prospectively. Results There were no deaths within 30 days. Two patients underwent Hartmann9s operation after early PEC dislodgement. There were no further hospital admissions for pseudo-obstruction or volvulus in the remaining 36 patients after 10.6 (range 1–79) months including four patients whose PEC device fell out at 8–10 months. Two patients died at 10 and 12 months, respectively, due to peritonitis and 13 patients died of unrelated causes. Conclusion PEC is a relatively safe treatment option in high-risk patients with colonic pseudo-obstruction/megacolon with or without volvulus and prevents further hospital admissions in all patients.