Guidance
2 The technology
Description of the technology
2.1 Peristeen Plus (Coloplast) is a transanal irrigation system for managing bowel dysfunction. The company's instructions for use in this indication recommend that it should be used every other day to empty the rectum and distal sigmoid colon, in order to prevent uncontrolled bowel movements (faecal incontinence) or to relieve and prevent constipation. Peristeen Plus is usually self-administered while sitting on a toilet, commode or shower chair. It comprises a rectal catheter with inflatable balloon or a cone catheter, a manual control unit with pump, leg straps and a bag with temperature gauge to hold water. Peristeen Plus uses a constant-flow pump which does not rely on gravity so that the user does not need to hang the bag up for the water to flow. Peristeen Plus needs a new catheter each time it is used.
There is no published evidence on Peristeen Plus with the cone catheter. This guidance therefore focuses on Peristeen Plus with the balloon catheter. [2022]
2.2 The cost of Peristeen Plus with the balloon catheter is £79.45 per system (comprising a Peristeen pump, 2 catheters, 2 straps and a water bag) and £138.47 per consumable pack of 15 catheters and replacement water bag (excluding VAT). [2022]
2.3 The claimed benefits of Peristeen Plus in the case for adoption presented by the company are that it:
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improves symptoms and reduces the severity of chronic constipation
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reduces the severity and frequency of faecal incontinence
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improves quality of life for people with bowel dysfunction
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reduces the incidence, frequency and costs associated with urinary tract infections
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reduces the rate of stoma surgery
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reduces the cost of treating neurogenic bowel dysfunction in people who have already had unsuccessful standard care
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reduces the rate of hospitalisation in people with neurogenic bowel dysfunction.
Current management
2.4 Bowel dysfunction may be caused by a neurogenic disorder (such as spinal cord injury, spina bifida, multiple sclerosis or Parkinson's disease), or by a non-neurogenic disorder (such as injury to the rectum or bowel, slow transit constipation or obstructed defaecation symptoms).
2.5 Current treatment options for bowel dysfunction include medication (oral drugs, suppositories and enemas), changes to diet, physiotherapy and surgery. People with bowel dysfunction may also be offered training to help manage their symptoms at home, using biofeedback, bowel washouts and manual removal of faeces.
2.6 The NICE guideline on managing faecal incontinence in adults states that a combination of management strategies is likely to be needed. People with faecal incontinence should therefore be offered advice on a range of coping strategies and treatment options and are encouraged to find the methods that work best for them. There is currently no NICE guidance on managing bowel dysfunction in children.
2.7 If bowel continence cannot be achieved by medication, changes to diet and physiotherapy and long-term management strategies such as transanal irrigation should be considered. A number of different transanal irrigation systems, including Peristeen Plus, are available. Clinicians and patients should discuss the options available and may try a number of devices before settling on a preferred system. Some patients may need or prefer surgery, most often a colostomy, ileostomy or a procedure to allow treatment with anterograde continence enemas (ACE procedure).