Safety and efficacy of a novel continence device in colostomy patients

Ostomy continence devices: a systematic review of the literature and meta-analysis

AIM

Colostomy complication rates range widely from 10% to 70%. The psychological burden on patients, leading to lifestyle changes and decreased quality of life (QoL), is one of the largest factors. The aim of this work was to assess the history and efficacy of ostomy continence devices in improving continence and QoL.

METHOD

In this PRISMA-compliant systematic review and meta-analysis, we searched PubMed, Scopus, Google Scholar and clinicaltrials.gov for studies on continence devices for all ostomies up to April 2023. Primary outcomes were continence and improvement in QoL. Secondary outcomes were leakage, patient's device preference and complications. Risk of Bias 2 and the revised tool to assess risk of bias in non-randomized studies of interventions (ROBINS-1) were used to assess risk of bias. Certainty of evidence was graded using GRADE.

RESULTS

Twenty-two studies assessed devices from 1978 to 2022. The two main types identified were ball-valve devices and plug systems. Conseal and Vitala were the two main devices with significant evidence allowing for pooled analyses. Conseal, the only currently marketed device, had a pooled rate of continence of 67.4%, QoL improvement was 74.9%, patient preference over a traditional appliance was 69.1%, leakage was 10.1% and complications was 13.7%. Since 2011, five studies have investigated experimental devices on both human and animal models.

CONCLUSION

Ostomy continence has been a long-standing goal without a consistently reliable solution. We propose that selective and short-term usage of continence devices may lead to improved continence and QoL in ostomy patients. Further research is needed to develop a reliable daily device for ostomy continence. Future investigation should include the needs of ileostomates.

Innovative appliance for colostomy patients: an interventional prospective pilot study

Background

The control of body waste emptying is a constant research topic in stoma care. The aim of this pilot study was to assess the efficacy and safety of an innovative colostomy appliance.

Methods

An interventional prospective non-comparative pilot study was conducted in seven French centers. The study device is a new type of two-piece appliance including a base plate and a “capsule cap” (CC) composed of a capsule cover and a folded collecting bag. The device gently seals the stoma to provide stoma output control. When the bowel movement pressure increases the patient may control the deployment of the folded bag and collect stools. Patients with left-sided colostomy all using a flat appliance, were enrolled in a 2-week trial. Outcome measures were type of CC removal and peristomal fecal leaks while wearing the device.

Results

Of 30 patients (females 66.7%), with left-sided colostomy (permanent 76.7%), 23 (76.7%) completed the 2-week trial. A total of 472 CC changes were analyzed. Efficacy: of 404 (85.5%) CC changes reported in diaries, 302 (74.8%) were linked with stool and/or gas. In 244 (60.3%) changes, the patient controlled stoma bag deployment and it occurred with bowel emptying 301 (74.5%) times. No leaks around the appliance were observed in 400 (85.3%) changes. Safety: no serious adverse event occurred. Peristomal skin was not modified during the trial.

Conclusions

In the short term this new device has provided an increased control over bowel emptying at no risk in half of the trial population suggesting that an alternative approach to bag wearing is achievable.

A health-related quality-of-life study comparing Vitala continence control device versus traditional pouch system only in patients with end colostomy

PURPOSE

The aim of this study was to evaluate the health-related quality-of-life (HRQL) impact of using the Vitala continence control device (CCD) in addition to the traditional pouch system among patients with an end colostomy.

MATERIALS AND METHODS

End colostomy patients aged 18 years or older from the Czech Republic, Netherlands, and UK who were using at least 15 Vitala CCDs per month for at least 3 months and those using only pouches were surveyed over the Internet when possible or alternatively using a local personal computer arranged by a professional recruiter. The survey included the EQ-5D, Stoma Quality of Life Scale, Stoma Appliance-specific Questionnaire (SAQ), in addition to demographics and medical history. Univariate and regression analyses were performed to compare the HRQL between the patient groups.

RESULTS

A total of 165 patients completed the survey: 103 (62.4%) from the Czech Republic, 11 (6.7%) from the Netherlands, and 51 (30.9%) from the UK. Of these, 70 (42%) were Vitala CCD users. The mean age (±SD) was 62.5 (±10.9) years and 61.2% of the patients were men. Patients using the Vitala CCD on average had significantly higher scores on EQ-5D utility (0.84±0.20 vs. 0.75±0.25, P=0.013), EQ Visual Analog Scale (77.0±17.06 vs. 71.2±18.49, P=0.043), and SAQ (27.1±4.21 vs. 24.9±4.29, P=0.001). The Stoma Quality of Life Scale scores did not differ significantly between the groups. A higher proportion of Vitala CCD users had 'no problems' on all five EQ-5D domains (44.3 vs. 25.3%, P=0.010). A higher proportion of Vitala CCD users' scores were at or above the mean score of patients indicating 'enjoyed life' 'most of the time', for both the EQ-5D (64.3 vs. 48.4%, P=0.043) and the EQ Visual Analog Scale (67.1 vs. 51.6%, P=0.045).

CONCLUSION

Findings from this study demonstrate that patients using the Vitala CCD appear to have better HRQL compared with those using only pouches. The difference might be meaningful to the patients, as reflected in the generic EQ-5D and the device-specific SAQ measures.