Antegrade continence enema treatment can lead to proximal colonic dilation while preserving motility in children with constipation

Introduction: The aim of this study was to evaluate colonic motility and anatomy in children treated with antegrade continence enema (ACE), utilizing colonic manometry (CM) and contrast enema (CE) studies. Methods: A retrospective review of patients treated surgically with ACE who underwent CM. Patient demographics, medical and surgical history, clinical symptoms, CM results, and CE results were recorded. Results: Seventy patients (59 % female, median age at time of CM of 10 years) with CM after starting ACE treatment were included, 74 % had a diagnosis of functional constipation. CM after ACE showed normal motility in 43 %, distal colonic dysmotility in 29 %, total colonic dysmotility in 21 %, and proximal colonic dysmotility in 6 %. In the children with CEs before and after starting ACE treatment (n = 25), 20 % developed proximal colonic dilation after ACE. These patients had a longer median duration of ACE treatment compared to those who did not have proximal colonic dilation (41 vs 16 months, p = 0.062). Flush volume and contents, response to flush, proximal colonic dysmotility, and underlying diagnosis did not differ between those who did and did not develop proximal colonic dilation after ACE. Conclusion: In patients treated with ACE, proximal colonic dysmotility was only seen in 6 %. Development of proximal colonic dilation was seen in 20 % of patients, with a longer duration of treatment potentially contributing to its occurrence. Future studies are needed to understand the impact of this anatomy change and translate our findings into best practice for management of these children.