Long-term outcome and safety of transanal colonic irrigation for neurogenic bowel dysfunction

Abstract

Methods: Between 1994 and 2007, 211 (115 female) patients with NBD (age: 7-81 years (median 49)) were introduced to TAI. One hundred and seventy-three patients had spinal cord injury and 38 had other neurological disorders. Data were obtained from hospital records and a mailed questionnaire. Treatment was considered successful in patients still using TAI, patients who had used TAI until they died and patients whose symptoms had resolved while using TAI. Results: Successful outcome was achieved in 98 (46%) patients after a mean follow-up of 19 months (range 1-114 months). A Kaplan-Meier plot showed a dropout of 20% in the first 3 months. After 3 years, the rate of success was 35% and remained almost unchanged afterwards. A regression analysis showed male gender (odds ratio (OR) 2.1), mixed symptoms (OR 2.9) and prolonged colorectal transit time (OR 2.4) to be significantly associated with successful outcome. One non-lethal bowel perforation occurred in approximately 50 000 irrigations (0.002%), whereas minor side effects were observed in 48%. Conclusion: After a mean follow-up of 19 months, 46% was successfully treated. The rate of success was 35% after 3 years and remained almost unchanged afterwards. TAI is safe and can be introduced to most patients suffering from NBD.

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

“…28 Uchikawa et al 28 developed a new procedure to induce bowel movements using a toilet set equipped with an electronic bidet that provides water flow to (Table 7). [29][30][31][32][33][34] There is Level 4 evidence (from one case-series study evaluating 31 persons with SCI) that supports using pulsed water irrigation (intermittent rapid pulses) to remove stool in individuals with SCI. 29 There is also Level 1 evidence (from one large good-quality multisite RCT with 87 subjects), 30 Level 4 evidence (from two pre-post study evaluating 55 and 32 persons with SCI), 31,32 and Level 5 evidence (from an observational study) 33 that support the use of the transanal irrigation systems.…”

“…[29][30][31][32][33][34] There is Level 4 evidence (from one case-series study evaluating 31 persons with SCI) that supports using pulsed water irrigation (intermittent rapid pulses) to remove stool in individuals with SCI. 29 There is also Level 1 evidence (from one large good-quality multisite RCT with 87 subjects), 30 Level 4 evidence (from two pre-post study evaluating 55 and 32 persons with SCI), 31,32 and Level 5 evidence (from an observational study) 33 that support the use of the transanal irrigation systems. In the RCT, the Peristeen Anal Irrigation system (Coloplast A/S, Kokkedal, Denmark) showed reduced frequency of lower urinary traction, improved fecal continence, and reduced constipation after 10 weeks of use when compared with the conservative bowel treatment (Paralyzed Veterans of America Clinical Practice Guidelines for Bowel Management).…”

“…31,32 In the Del Popolo et al 32 study, 9 out of 32 study subjects also either reduced or eliminated their use of pharmaceuticals. In the observational study, Faaborg et al 33 found 98 of the 211 patients had successful outcomes after a mean follow-up of 19 months, and 74 patients were successfully using irrigation techniques after 3 years. In this study, successful outcomes were defined as irrigation still being used during follow-up, patients who used irrigation until they died, and patients whose symptoms had resolved while using irrigation techniques.…”

Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction

“…Follow-up studies have described the successful long-term use of TAI in the SCI population. Two similar studies, 20,21 each with follow-up of nearly 10 years, assessed treatment success (defined as the patient still using TAI at follow-up, or whose symptoms had resolved while using it, or who had died from unrelated causes while using it). The irrigation systems used included rectal balloon catheters and systems with a cone-shaped colostomy tip.…”

“…The irrigation systems used included rectal balloon catheters and systems with a cone-shaped colostomy tip. 20,21 Both studies included adults and children with bowel dysfunction of various aetiologies. For 74 patients with traumatic SCI, the success rates were 50% for complete injuries, 58% for high incomplete injuries and 53% for low incomplete injuries.…”