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Efficacy of Peristeen transanal irrigation system for neurogenic bowel in the pediatric population
Tiffany Gordon, MSN, CPN, CRRN
Dr. David Vandersteen, MD
Objective:
Fecal incontinence and chronic constipation are significant medical and social concerns for patients with neurogenic bladder. Peristeen^® (Coloplast) transanal irrigation has been utilized outside the US for the management of these patients since 2006. Peristeen^® was approved for use in the United States in 2012. The purpose of this study is to determine efficacy of the Peristeen^® transanal irrigation system in (a select group) of pediatric patients with neurogenic bowel (who had failed other bowel management programs). Most of these patients suffered from Spina Bifida.
Materials and Methods:
Patients were referred for Peristeen^® from our neurogenic bowel and bladder clinic as well as from providers outside of our system. All patients referred for peristeen were included in the study. There were no exclusion criteria. Patients were assessed using the Neurogenic Bowel Dysfunction Score (NBDS) upon entry, at 3 months, 6 months, and 1 year. Patients were also assessed regarding prior bowel management programs and treatment failures. Patients were also assessed for complications of treatment. The data were acquired prospectively and reviewed retrospective for the purposes of this study.
Results:
A total of 51 patients were referred for Peristeen^®. 6 patients were denied or are awaiting insurance approval for treatment. 7 patients were approved for Peristeen^® but have decided not to move forward with this teaching right now. 35 patients received insurance approval for treatment and have had Peristeen^® teaching; they are the treatment study group. All patients in the study group had failed one or more bowel management programs (BMP), including 2 patients with prior ACE procedure, 24 patients with prior enema programs and 11 patients on oral agents only. NBDS improved in 73% at 3 months f/u, and in 100% at 6 m f/u. Detailed analysis of the individual items within the NBDS demonstrated more improvement in number of incontinent bowel episodes and time spent doing BMP. 9% of patients failed treatment (Only 3
patients, just something to try before surgery). Of patients with prior ACE, 100% had success with Peristeen. There were no complications of treatment.
Conclusion:
Peristeen^® transanal irrigation system is an effective and safe means of managing Neurogenic Bowel in the pediatric population. There appears to be a learning curve with results improving between 3 and 6 months of initiation of therapy. Prior failure of ACE irrigation or other enema programs did not predispose to failure of Peristeen^®.