The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on percutaneous endoscopic colostomy.
Percutaneous endoscopic sigmoid colostomy (PEC) is a variation of the percutaneous endoscopic gastrostomy technique which has been well established for enteral gastric feeding since 1980.
A colonoscope is inserted into the left colon per rectum until transillumination is seen through the skin surface and finger pressure indents the colon. The PEG tube kit is passed through the scope with the snare. Under local anaesthesia, a small incision is made in the skin and a hollow needle is passed through the abdominal wall into the bowel. The snare passes over the visualised needle to grasp it and is then withdrawn with the wire and colonoscope through the anal canal.
A 20F catheter system is securely tied with wire and pulled retrogradely through the bowel and abdominal wall and is then secured against the abdominal wall. To check the final position of the catheter, the colonoscope is reinserted. The catheter is then attached to a drainage bag, flushed twice a day and antibiotics are administered for five days postoperatively. This tube can be in situ for the long term or short term, depending on indications for use.
PEC can be used:
- to treat recurrent sigmoid volvulus
- acute colonic pseudo-obstruction
- faecal constipation
- faecal incontinence
- for the delivery of anti-inflammatory agents for patients with colitis
PEC offers an alternative treatment for patients who have tried conventional treatment options without success. Various surgical techniques as an alternative to PEC include sigmoidopexy, sigmoidoplasty, trephine stoma to resection with primary anastomosis. Traditional treatment options for sigmoid volvulus comprise endoscopic decompression and/or open resection. However, these treatment options have varying success with endoscopic decompression having a recurrence rate of approximately 40% and open resection may be contraindicated for frail, elderly patients or the severely immunocompromised.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.