Comparison of antegrade continence enema treatment and sacral nerve stimulation for children with severe functional constipation and fecal incontinence

Abstract

Background To compare antegrade continence enema (ACE) treatment and sacral nerve stimulation (SNS) in children with intractable functional constipation (FC) and fecal incontinence (FI). Methods We performed a retrospective review of children 6‐18 years old with FC and FI treated with either ACE or SNS at our institution. We recorded symptoms at baseline, 6 months, 12 months, 24 months, and their most recent visit after starting treatment. We compared improvement in FI, bowel movement (BM) frequency, abdominal pain, laxative use, and complications. Patients were contacted to evaluate perceived benefit using the Glasgow Children's Benefit Inventory. Key Results We included 23 patients treated with ACE (52% female, median age 10 years) and 19 patients treated with SNS (74% female, median age 10 years). Improvement in FI was greater with SNS than ACE at 12 months (92.9% vs 57.1%, P = .03) and 24 months (100% vs 57.1%, P = .02). Improvement in BM frequency was greater with ACE, and children were more likely to discontinue laxatives at all follow‐up time points (all P < .05). Improvement in abdominal pain was greater with ACE at the most recent visit (P < .05). Rate of complications requiring surgery was similar between groups (26.3% vs 21.7%). Benefit was reported in 83.3% and 100% of ACE and SNS groups, respectively (NS). Conclusions and Inferences Although both ACE and SNS can lead to durable improvement in children with FC and FI, SNS appears more effective for FI and ACE more effective in improving BM frequency and abdominal pain and in discontinuation of laxatives.

Diagnosis and management of fecal incontinence in children and adolescents

“…ACE has been evidenced to be useful in the management of NBD, which is characterized by chronic constipation and/or FI; ACE via cecostomy or MACE had similar continence outcomes ( 66 ). A retrospective review of 6–18-year-old children with FC and FI treated with either ACE or SNS showed that SNS was more effective against FI and ACE in improving the stool frequency and soothing abdominal pain ( 67 ). Another comparative study by Born et al reported that MACE might be more attractive than cecostomy tube in avoiding repeated procedures and radiation exposure ( 68 ).…”

Pediatric gastrointestinal neuromodulation

“…[ 47 ] A retrospective review of pediatric patients with functional constipation and functional incontinence who were treated with either ACE or SNS showed that although both ACE and SNS lead to improvement in both pediatric functional constipation and functional incontinence, SNS was more effective for functional incontinence and ACE was more effective for improving bowel movement frequency, abdominal pain, and laxative discontinuation. [ 48 ]…”

Surgical Interventions for Functional Constipation: An Update

“…ACE increased the number of bowel movements per week and decreased abdominal symptom, and SNS decrease episodes of FI after 2 years of treatment. 31 It is important to consider how longer term follow-up will be able to provide more information regarding the compliance of the patient, proposed duration of therapy, and the sustainability of a benefit of the neuromodulation while it is in use, and after it is discontinued. It also seems important to highlight that the majority of the published papers on the use of SNS therapy have been published by a single center.…”

“…In the future, evaluation of other centers' experience, will make it easier to have a better understanding of the results and the outcomes of SNS. 28,31…”