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Antegrade continence enema (ACE): predictors of outcome in 111 patients.
[hirschsprung disease]
The
antegrade
continence
enema
(
ACE
)
is
used
as
a
means
of
managing
faecal
incontinence
and
constipation
with
varying
outcomes
.
We
aim
to
evaluate
our
outcomes
of
ACEs
and
identify
predictors
of
outcome
.
A
retrospective
case-note
review
of
patients
≤
16
years
of
age
undergoing
an
ACE
(
March
2000
-
September
2013
)
was
carried
out
.
Data
collected
included
:
patient
demographics
,
functional
outcomes
and
complications
.
Data
are
quoted
as
median
(
range
)
and
compared
using
Mann-
Whitney
and
Fisher
's
exact
test
.
Univariate
analysis
was
performed
to
identify
predictors
of
successful
outcomes
.
P
<
0
.
05
is
significant
.
Successful
outcome
=
total
continence
/
occasional
leakage
and
failed
outcome
=
regular
soiling
and
/
or
constipation
.
111
patients
with
complete
data
sets
underwent
an
ACE
[
59
%
male
,
median
age
=
9
.
5
years
(
3
.
4
-
16
years
)
]
and
median
follow-up
=
48
months
(
4
months
-
11
years
4
months
)
.
Underlying
diagnoses
were
idiopathic
constipation
(
n
=
68
)
,
anorectal
malformation
(
n
=
27
)
,
neuropathic
bowel
(
n
=
7
)
,
Hirschsprung
disease
(
n
=
5
)
and
gastrointestinal
dysmotility
(
n
=
4
)
.
Social
continence
was
achieved
in
87
/
111
(
78
%
)
.
Fifteen
percent
of
patients
underwent
reversal
of
ACE
due
to
resolution
of
symptoms
.
There
was
no
difference
in
outcomes
related
to
diagnosis
,
gender
,
age
or
follow-up
duration
.
Complication
rate
was
20
.
7
%
(
23
/
111
)
.
The
ACE
is
safe
and
effective
in
the
management
of
intractable
constipation
and
soiling
.
No
predictors
of
outcome
were
identified
.
