Letter to Editor Comments on: Antegrade continence enema treatment can lead to proximal colonic dilation while preserving motility in children with constipation

jpedsurg.org

We read with interest the retrospective study by van der Zande and colleagues [1] evaluating colonic motility and anatomy in 70 children treated with antegrade continence enema (ACE). The authors report proximal colonic dysmotility in 6% and proximal dilation in 20% of patients with paired contrast enema (CE) data, with longer ACE duration as a contributing factor. This work addresses an important clinical question. However, we wish to raise three methodological considerations.

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Article · Mar 2026 · 1 min read

In brief

This letter responds to a study examining colonic motility and dilation in children receiving antegrade continence enema (ACE) therapy for constipation. The authors raise three methodological concerns about the retrospective analysis that found proximal colonic dilation in 20% of patients with longer ACE treatment duration.

ACE treatment may cause proximal colonic dilation in 20% of pediatric patients, particularly with longer treatment duration.
Proximal colonic dysmotility was observed in 6% of children undergoing ACE therapy based on contrast enema findings.
Methodological concerns exist regarding retrospective ACE studies; clinicians should monitor for proximal complications during treatment.
Paired contrast enema data is valuable for assessing anatomical and motility changes in children receiving long-term ACE therapy.

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