The evidence on the safety of Barnett Continent Intestinal Reservoir (modified continent ileostomy) to restore continence after colon and rectum removal shows that there are serious but well-recognised safety concerns. Current evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.
Clinicians wishing to do Barnett Continent Intestinal Reservoir (modified continent ileostomy) to restore continence after colon and rectum removal should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. They should provide them with clear written information to support shared decision making. In addition, the use of NICE's information for the public is recommended.
Audit, review and publish clinical outcomes of all patients having Barnett Continent Intestinal Reservoir (modified continent ileostomy) to restore continence after colon and rectum removal. This guidance requires that clinicians doing the procedure make special arrangements for audit. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion).
The procedure should only be done by experienced colorectal surgeons with training and mentoring in the specific technique.
Further research should include details of patient selection, durability and the incidence of complications. Outcomes should be published.