Endoscopic trans-anal tube placement is a safe and helpful tool for colonic decompression: final results of a standardized single-centre retrospective assessment of 125 patients

Abstract

Objectives Endoscopic trans-anal colonic decompression (ECD) may be requested in the case of massive colon distension, but evidence regarding success and safety issues remains scarce. The aim of this analysis is to examine the technical success, complications and clinical outcome in a large series of patients undergoing an ECD in various clinical scenarios. A standardized evaluation system was used to identify the pre-interventional risk parameters that might be helpful to guide clinical decision making.

Methods In this single-centre retrospective study, the modified Clavien–Dindo classification (CDC) was applied to assess technical success, complications and clinical outcome of 125 consecutive patients who underwent ECD between 2007 and 2020. Primary endpoint: post interventional 90-day mortality. Secondary endpoints: periprocedural complications (CDC event IV-V) and technical success rate. All Martin criteria for standardized reporting of complications were met. Uni- and multivariable analyses for prediction of complications were carried out.

Results The overall technical success rate was 90%. The periprocedural complication rate was low with 3%. Overall 90-day mortality was 31%. Univariable analyses showed a significant correlation between 90-day mortality and ASA≥4 (p<0.001, odds ratio [OR] 15.33), general anaesthesia (p=0.05, OR 21.42) and elevated serological infection parameters (p 0.028, OR 1.004). The pre-interventional multivariable model identified ASA ≥4 (p <0.001; OR 10.94) as the only independent risk factor.

Conclusions ECD is a safe, easily available, technical feasible, inexpensive and successful tool for colonic decompression in various colonic obstruction scenarios, even in critically ill patients. ASA Score ≥IV can be helpful to identify patients at risk for complications/mortality after ECD.

Zusammenfassung

Einleitung Eine endoskopisch angelegte Kolondekompressionssonde kann im Falle einer massiven Kolondistension indiziert sein. Die Datenlage zur Sicherheit, Effektivität & Risikoprädiktion ist unklar.

Ziele Der technische Erfolg, die Komplikationen & das klinische Ergebnis der Sondenanlage wurden in einer großen Serie von Patienten in verschiedenen klinischen Szenarien untersucht.

Methodik In dieser monozentrischen, retrospektiven Studie mit 125 Patienten wurde die Clavien-Dindo-Klassifikation (CDC) zur Komplikationsbeurteilung angewendet. Indikationen für die Anlage einer Sonde waren in 88% eine benigne und in 12% eine maligne Ursache. Primärer Endpunkt: postinterventionelle 90-d-Mortalität. Sekundäre Endpunkte: periprozedurale Komplikationen (CDC IV-V) & technische Erfolgsrate. Uni- & multivariate Analysen wurden zur Identifikation von möglichen prädiktiven Parametern von Komplikationen durchgeführt.

Ergebnis Die technische Erfolgsquote betrug 90 %. Die periprozedurale Komplikationsrate war 3 %. Die 90-d-Mortalität betrug 31 %. Univariable Analysen zeigten eine signifikante Korrelation zwischen 90-d-Mortalität & ASA=4 (p<0,001), Allgemeinanästhesie (p=0,05), serologischen Infektionsparametern (p=0,028). Die multivariate Analyse identifizierte ASA = 4 (p < 0,001) als relevanten unabhängigen Risikofaktor.

Diskussion Die endoskopische Dekompressionssonde ist sicher, leicht verfügbar, einfach, kostengünstig & erfolgreich zur Kolondekompression in verschiedenen klinischen Szenarien.

Keywords

Endoscopic colonic decompression - trans anal tube placement - Ogilvie-syndrome

Schlüsselwörter

Endoskopische Kolon-Dekompression - transanale Kolondekompressionssonde - Olgive-Syndrom

Publikationsverlauf

Eingereicht: 08. September 2022

Angenommen nach Revision: 23. November 2022

Artikel online veröffentlicht:
20. Januar 2023

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