Body Fit With a Pouching System With Concave Contour for People With an Outward Peristomal Body Profile: Effects on Leakage, Wear Time, and Quality of Life: A Randomized Controlled Cross-Over Trial

PURPOSE

The purpose of the study was to investigate the fit of a two-piece pouching system with a concave-shaped skin barrier on people with an outward peristomal body profile and its effect on leakage, wear time, and quality of life (QoL) related to using an ostomy product.

DESIGN

Randomized, controlled, open-label, cross-over trial.

SUBJECTS AND SETTINGS

The sample comprised 53 subjects with outward peristomal body profiles and problems with leakage of ostomy effluent from their pouching system. Participants were randomized to the concave two-piece pouching system or a comparator (two-piece pouching system with a flat skin barrier) for 3 weeks. Subjects were then crossed over to the opposite skin barrier for an additional 3 weeks. The study was conducted in Denmark, Norway, Germany, and the Netherlands; data were collected in multiple ambulatory clinics or during home visits.

METHODS

The primary end point was the ability of the skin barrier to fit body contours; secondary outcomes were leakage of effluent from the pouching system, wear time, and QoL related to using an ostomy product via the validated Ostomy-Q questionnaire. Primary comparisons between concave and comparator pouching systems were evaluated using proportional odds models and mixed models taking test period into account.

RESULTS

Analysis included randomized subjects who had been exposed to at least one product and with information on at least one end point (full-analysis-set, n = 52). The concave pouching system provided a better fit to body contours than the comparator (P< .001) and reduced the degree of leakage underneath the skin barrier (LS mean difference = -1.84, 95% CI -3.31 to -0.37; P = .016). Participants experienced fewer episodes of leakage outside the skin barrier when using concave versus comparator pouching system (13.0% vs. 26.7%, respectively). Participants reported significant improvements in QoL (LS mean difference = 14.3; 95% CI 9.4 to 19.2; P < .001). No significant difference in wear time between skin barrier shapes was reported.

CONCLUSIONS

Study findings indicate that a pouching system with a concave skin barrier achieved a better body fit on people with an outward peristomal body profile and resulted in fewer leakage incidents and higher QoL compared to using a pouching system with a flat skin barrier.

Use of a Convex Pouching System in the Postoperative Period: A National Consensus

Convex pouching systems have been available for ostomy patients for decades; however, controversy remains over the use of convexity in the postoperative period. A group of 10 nurses and physicians with expertise caring for patients with an ostomy completed a scoping review identifying research-based evidence and gaps in our knowledge of the safety and effectiveness related to the use of a convex pouching system following ostomy surgery. Results of this scoping review demonstrated the need for a structured consensus to define best practices when selecting a pouching system that provides a secure and reliable seal around the stoma, avoids undermining and leakage of effluent from the pouching system, and contributes to optimal health-related quality of life for patients following ostomy surgery. The expert panel reached consensus on 8 statements for the use of convex products immediately after surgery and throughout the first 6 months after stoma creation, as well as describing goals in choosing the best pouching system for the patient with an ostomy.

Factors predictive of optimal peristomal skin status in patients with an ostomy: a secondary analysis

Peristomal skin problems are common in ostomy patients and are connected to decreased quality of life and patient independence, as well as increased treatment costs. This study analysed the factors related to peristomal skin changes in order to better define the clinical profile of patients with optimal peristomal skin status. Secondary analysis of data from a nationwide, cross-sectional, retrospective, multicentre study performed in Spain (Uses and Attitudes in Ostomy) (Bueno Cruz et al, 2021) evaluated clinical data, including demographics, preoperative stoma site marking, type of ostomy, device used, frequency of leakage and scores from the Ostomy Skin Tool (OST) and quality of life (QoL) questionnaires. Risk factors for peristomal skin changes were analysed using multivariate analysis, and a predictive nomogram to anticipate optimal peristomal skin status (defined here as discolouration (D), erosion (E), and tissue overgrowth (T) (DET) score of 0) was developed. Some 871 patients with an ostomy using different commercial devices in Spain were evaluated. Multivariate analysis to predict optimal peristomal skin status revealed leakage frequency, patient age, type of ostomy, preoperative siting and type of baseplate used were independent predictors of peristomal skin status. Optimal peristomal skin care should be a treatment goal for nurse specialists in stomal therapy, and its individual influencing variables should be taken into account by nurses specialising in ostomy care.

Novel stoma appliances to minimise complications and improve patient outcomes

Stomas are created for a number of reasons and, if they are formed without the opportunity for preoperative care and consideration, such as siting, stoma care needs can be more complex in the long term. Patient quality of life can be negatively affected by the incidence of stoma related complications, such as leakage or sore skin. A new range of products, Aura Plus, distributed by CliniMed Ltd in the UK, were evaluated on more than 200 patients with a stoma and assessed for comfort, ease of application, security and leakage. Case studies highlight positive patient outcomes following the use of Aura Plus, and demonstrate how Aura Plus can benefit patients experiencing different needs with their stoma care, such as leakage, peristomal skin complications or a parastomal hernia.

Convexity in stoma care: developing a new ASCN UK guideline on the appropriate use of convex products

One of the biggest challenges for specialist stoma care nurses (SCNs) caring for anyone living with a stoma is that of being confronted with a problematic stoma. This can be described as an ostomy that continues to cause leakage issues for the patient which, if persistent can quickly impact negatively on their quality of life. A convex stoma appliance, also termed convexity, is a possible solution to a problematic stoma. However, the use of a convex appliance should be considered only after a thorough assessment has been undertaken by a specialist SCN. Professionally, stoma care nursing has advanced greatly in recent years and there has been a realisation that there is a need for clinical guidelines to direct practice and offer a process for the novice SCN to follow. This realisation has been the catalyst behind the development of the new guideline for the assessment and use of convexity by the Association of Stoma Care Nurses UK, which was published this year (https://ascnuk.com/). This article explores the concept of convexity and how the guideline can assist the practice of specialist SCNs, as well as that of ward and community-based nurses who wish to gain more information on using convexity within the specialist sphere of stoma care.

Selecting convexity to improve and maintain peristomal skin integrity

Each person with a stoma is an individual who may react differently when faced with similar situations and, as such, each patient needs to be considered on a person-by-person basis to address their needs, support their acceptance of living with a stoma, as well as to encourage their rehabilitation. This article discusses the benefits that a convex flange can offer ostomates to reduce and minimise leakage episodes and in doing so support peristomal skin integrity and, in particular, the benefits of a convex pouch with a hydrocolloid flange containing medical grade Manuka honey. It reports on the findings of an independent nurse study, which included discussions about the varying types of convexity offered to ostomates, following an assessment of patients' needs.

Risk factors and treatment outcomes of peristomal pyoderma gangrenosum in patients with inflammatory bowel disease

BACKGROUND

Insufficient data exist for peristomal pyoderma gangrenosum (PPG), which primarily affects patients with inflammatory bowel disease (IBD).

AIMS

To evaluate the risk factors and treatment response of PPG in IBD patients in a real-life cohort.

METHODS

Cases of PPG were identified retrospectively using ICD-9/10 codes in patients with IBD who had an ostomy at a tertiary care centre. Disease-specific characteristics were compared between groups with and without PPG, and response to therapy was evaluated in patients with PPG.

RESULTS

The cohort included 41 IBD patients with PPG and 123 IBD controls with an ostomy who never developed PPG. Patients with PPG were more likely to be female (76% vs 51%, P = 0.006), had higher BMIs (29.78 ± 0.89 vs 23.53 ± 0.51, P < 0.0001) and had increased usage of pouch belts (97% vs 71%, P = 0.0008) compared to controls. There were no differences in age at surgery (41.76 ± 2.60 vs 43.49 ± 1.50, P = 0.57) or IBD diagnosis (63% vs 54% Crohn's disease, P = 0.28) between PPG and controls. 85% of PPG patients achieved complete resolution with different treatments, including surgery. Complete resolution with topical corticosteroids and calcineurin inhibitors alone were low (14% and 13% respectively). Higher rates of complete resolution were reported with anti-tumour necrosis factor (TNF) agents (63%) and surgical interventions (80%).

CONCLUSIONS

Female gender, higher BMI and pouch belts were associated with increased risk of developing PPG. Most PPG cases resolved after treatment with the highest rates of complete resolution seen with anti-TNF agents and surgical intervention.