Randomized clinical trial on the use of a colon-occlusion device to assist rectal washout

Carolin Cordewener, Manuel Zürcher, Philip C Müller, Beat P Müller-Stich, Andreas Zerz, Georg R Linke, Daniel C Steinemann, Carolin Cordewener, Manuel Zürcher, Philip C Müller, Beat P Müller-Stich, Andreas Zerz, Georg R Linke, Daniel C Steinemann

Abstract

Background: Transrectal Natural Orifice Transluminal Endoscopic Surgery is currently limited by the inherent risk of surgical site infection due to peritoneal contamination after rectotomy. Coloshield has been developed as a temporary colon occlusion device to facilitate rectal washout. However, effectiveness and safety has not been evaluated in humans.

Methods: Twenty-two patients have been randomly assigned to undergo proctological intervention with a rectal washout with and without the use of Coloshield. Patients and assessors were blinded. Boston Bowel Preparation Scale (BBPS) has been determined 30 min as well as immediately after rectal washout. Feasibility, pain, intra- and postoperative morbidity as well as bowel function and continence 6 weeks after surgery were assessed.

Results: BBPS 30 min after rectal washout with and without Coloshield was in mean 2.42 ± 1.02 and 2.12 ± 0.89 (p = 0.042). Mean BBPS immediately after rectal washout was 2.39 ± 1.02 and 2.24 ± 0.66 (p = 0.269). Mean BBPS immediately after rectal washout and 30 min thereafter did not differ (p = 0.711). Coloshield application was feasible without any complications. The median (interquartile range) numeric rating scale for pain 4 h after surgery was 1 (0-1) and 3 (0-4) (p = 0.212). Six weeks after surgery 0/11 and 1/11 patients suffered from evacuation difficulties (p = 1.0) and the median Vaizey-Wexner score was 1 (0-3) and 1 (0-2) (p = 0.360).

Conclusions: Coloshield application in humans is feasible and safe. Slight benefits in rectal preparation by washout are found when Coloshield is used. Colon occlusion by Coloshield for transrectal NOTES should be evaluated within clinical studies.

Trial registration: Clinicaltrials.gov NCT02579330.

Keywords: Colon occlusion; Natural orifice transluminal endoscopic surgery; Peritoneal contamination; Proctology; Transrectal.

Conflict of interest statement

The Coloshield devices used in this trial were provided at no costs by A.M.I, Feldkirch, Austria. No further compensations, however, were obtained. C. Cordewener, M. Zürcher, P.C. Müller, B.P.Müller-Stich, A. Zerz, G.R. Linke, and D.C.Steinemann have no conflicts of interest or financial ties to disclose.

© 2020. The Author(s).

Figures

Fig. 1
Fig. 1
Examples of photographs of the rectal wall with A Bowel Preperation Scale (BBPS) of 0, B BBPS of 1, C BBPS of 2, D BBPS of 3
Fig. 2
Fig. 2
Coloshield with A double balloon catheter tip, B suction zone, C connection tube to fill and suck, and D introducer
Fig. 3
Fig. 3
A Set-up with 1. Coloshield inserted, 2. Rectoscope, and 3. vacuum pump; B Insertion of Coloshield device through rectoscope. C Rectal wash-out with saline solution through a rectal tube
Fig. 4
Fig. 4
Consort flow diagram
Fig. 5
Fig. 5
Boston Bowel Preparation Scale in the Coloshield group and the control group before wash-out, after wash-out, and 30 min after wash-out

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Source: PubMed

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