Peer-reviewed article

One-year outcomes for patients undergoing antegrade continence enema procedures without prior rectal enema therapy: a Pediatric Colorectal and Pelvic Learning Consortium study.

McNevin K, McClure PL, Ahmad H, Avansino J, Rice-Townsend S et al. · 8 Oct 2026

Abstract

Purpose Antegrade continence enemas (ACE) delivered through surgically placed channels help achieve social continence in children with colorectal disorders. Historically, a successful rectal enema program was required before ACE creation, but high-volume centers increasingly perform ACE upfront, particularly for patients intolerant of rectal enemas. This study describes a cohort of patients who underwent upfront ACE for bowel management within a multicenter consortium of high-volume pediatric colorectal centers, with 30-day and one-year outcomes. Methods We retrospectively evaluated patients who underwent a primary ACE channel at institutions participating in a multicenter pediatric colorectal consortium (2017-2025), excluding those with a redo ACE or a pre-existing ostomy. Results Among 171 patients who underwent upfront ACE (median age 7.0 years), diagnoses included anorectal malformation (54.4%), functional constipation (36.3%), and Hirschsprung disease (9.9%); approximately one-third had an associated psychiatric or neurodevelopmental diagnosis. Most had already failed oral laxative therapy (71.3% vs 37.6% of the 402 patients treated with rectal enemas before ACE). Complication rates were low at 30 days (6.4%) and one year (11.1%), comparable to those of the prior-enema cohort. At one year, 90.0% (117/130) were still using ACE flushes as their primary bowel management, and 6.4% (11/171) had discontinued flushes, none because of an inability to manage constipation or incontinence. Toilet-based stooling, which is the denominator from which the registry records stool accidents, was achieved in 70.5%, similar to the prior-enema cohort (74.6%). Among patients who stooled in a toilet, 56.0% reported no stool accidents. Conclusion Upfront ACE was associated with low complication rates and successful bowel management at one year, with 90.0% continuing ACE flushes and no discontinuations attributable to failure of bowel management. These outcomes were achieved within established multidisciplinary colorectal programs and may not be reproducible in settings without comparable longitudinal support. Further investigation is needed to assess long-term success and compliance and to identify populations who would benefit most from this approach.