Treatment Efficacy of Sacral Nerve Stimulation in Slow Transit Constipation: A Two-Phase, Double-Blind Randomized Controlled Crossover Study

Dinning, Phil G.; Hunt, Linda M.; Patton, Vicki; Zhang, Teng; Szczesniak, Michal; Gebski, Val; Jones, Michael; Stewart, Peter; Lubowski, David Z.; Cook, Ian J.

doi:10.1038/ajg.2015.101

Cited by 114 publications

(127 citation statements)

References 38 publications

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“…Still, other studies used terms like “several years” . One study did not specify the duration of constipation . Constipation was described as severe in three studies, refractory in six, and intractable in three studies …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Searching for a definition for pharmacologically refractory constipation: A systematic review

Soh

Kang

Siah

et al. 2018

J of Gastro and Hepatol

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Section: Resultsmentioning

confidence: 99%

“…All studies described a failure of medical therapy such as laxatives, dietary modification, or biofeedback . Only two studies required patients to have failed a 4‐week run‐in period of medical therapy such as fiber, laxatives, enemas, and suppositories.…”

Section: Resultsmentioning

confidence: 99%

Searching for a definition for pharmacologically refractory constipation: A systematic review

Soh

Kang

Siah

et al. 2018

J of Gastro and Hepatol

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“…The effects of SNS on colonic transit and rectal evacuation were only evaluated in a subset of patients; some parameters improved. By contrast, in a prospective, 18-week randomized, double-blind, placebo-controlled, two-phase crossover study, neither sub- nor supra-sensory SNS increased the proportion of complete bowel movements compared to sham SNS in 55 patients with medically-refractory slow transit constipation and normal anorectal functions evaluated with manometry, rectal balloon expulsion, and proctography 69 . Hence, although small studies suggest that SNS may improve rectal sensation in patients with DD and rectal hyposensitivity 70 and induce colonic propagating sequences 71 , there is no evidence that SNS improves bowel symptoms or rectal evacuation in defecatory disorders.…”

Section: Sacral Nerve Stimulation (Sns) For Defecatory Disordersmentioning

confidence: 76%

Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders

Bharucha

Rao

Shin

2017

Clinical Gastroenterology and Hepatology

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Description The purpose of this clinical practice update expert review is to describe the key principles in the use of surgical interventions and device-aided therapy for managing fecal incontinence (FI) and defecatory disorders. Methods The best practices outlined in this review are based on relevant publications, including systematic reviews and expert opinion (when applicable). Best practice advice 1 A stepwise approach should be followed for management of FI. Conservative therapies (diet, fluids, techniques to improve evacuation, a bowel training program, management of diarrhea and constipation with diet and medications if necessary) will benefit approximately 25% of patients and should be tried first. Best practice advice 2 Pelvic floor retraining with biofeedback therapy is recommended for patients with FI who do not respond to the conservative measures indicated above. Best practice advice 3 Perianal bulking agents such as intraanal injection of dextranomer may be considered when conservative measures and biofeedback therapy fail. Best practice advice 4 Sacral nerve stimulation should be considered for patients with moderate or severe FI in whom symptoms have not responded after a 3 month or longer trial of conservative measures and biofeedback therapy and who do not have contraindications to these procedures. Best practice advice 5 Until further evidence is available, percutaneous tibial nerve stimulation should not be used for managing FI in clinical practice. Best practice advice 6 Barrier devices should be offered to patients who have failed conservative or surgical therapy, or in those who have failed conservative therapy who do not want or are not eligible for more invasive interventions. Best practice advice 7 Anal sphincter repair (sphincteroplasty) should be considered in postpartum women with FI and in patients with recent sphincter injuries. In patients who present later with symptoms of FI unresponsive to conservative and biofeedback therapy and evidence of sphincter damage, sphincteroplasty may be considered when perianal bulking injection and sacral nerve stimulation are not available or have proven unsuccessful. Best practice advice 8 The artificial anal sphincter, dynamic graciloplasty, may be considered for patients with medically-refractory severe FI who have failed treatment or are not candidates for barrier devices, sacral nerve stimulation, perianal bulking injection, sphincteroplasty and a colostomy. Best practice advice 9 Major anatomic defects (e.g., rectovaginal fistula, full thickness rectal prolapse, fistula in ano, or cloacalike deformity) should be rectified with surgery. Best practice advice 10 A colostomy should be considered in patients with severe FI who have failed conservative treatment and have failed or are not candidates for barrier devices, minimally invasive surgical interventions, and sphincteroplasty. Best practice advice 11 A magnetic anal sphincter device may be considered for patients with medically refractory severe FI who have failed o...

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“…Recent randomized double-blind crossover studies have shown no difference between active and sham stimulations [17, 19]. In both studies, 30–60% of patients had a positive response during sham stimulation, suggestive of either lasting effects of sensory stimulation beyond washout period between sham and active treatment (2–3 weeks) or high placebo effects of this treatment.…”

Section: Discussionmentioning

confidence: 89%

“…Suprasensory stimulation (a stimulation above sensory perception threshold) has been shown to increase colonic propagation which suggests the SNM affects afferent pathway modulation [16] although the precise mechanism is unclear. A recent randomized controlled trial by the same authors, however, showed no difference in the number of complete bowel movements between sham, subsensory and suprasensory stimulation [17]. Although it is likely that SNM modulates both local and central pathways, data to date are too sparse to allow a meaningful understanding of the association between the physiological findings and improvement of clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of sacral neuromodulation for chronic refractory constipation

et al. 2017

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PurposeSacral neuromodulation has been reported as a treatment for severe idiopathic constipation. This study aimed to evaluate the long-term effects of sacral neuromodulation by following patients who participated in a prospective, open-label, multicentre study up to 5 years.MethodsPatients were followed up at 1, 3, 6, 12, 24, 36, 48 and 60 months. Symptoms and quality of life were assessed using bowel diary, the Cleveland Clinic constipation score and the Short Form-36 quality-of-life scale.ResultsSixty-two patients (7 male, median age 40 years) underwent test stimulation, and 45 proceeded to permanent implantation. Twenty-seven patients exited the study (7 withdrawn consent, 7 loss of efficacy, 6 site-specific reasons, 4 withdrew other reasons, 2 lost to follow-up, 1 prior to follow-up). Eighteen patients (29%) attended 60-month follow-up. In 10 patients who submitted bowel diary, their improvement of symptoms was sustained: the number of defecations per week (4.1 ± 3.7 vs 8.1 ± 3.4, mean ± standard deviation, p < 0.001, baseline vs 60 months) and sensation of incomplete emptying (0.8 ± 0.3 vs 0.2 ± 0.1, p = 0.002). In 14 patients (23%) with Cleveland Clinic constipation score, improvement was sustained at 60 months [17.9 ± 4.4 (baseline) to 10.4 ± 4.1, p < 0.001]. Some 103 device-related adverse events were reported in 27 (61%).ConclusionBenefit from sacral neuromodulation in the long-term was observed in a small minority of patients with intractable constipation. The results should be interpreted with caution given the high dropout and complication rate during the follow-up period.

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Treatment Efficacy of Sacral Nerve Stimulation in Slow Transit Constipation: A Two-Phase, Double-Blind Randomized Controlled Crossover Study

Abstract: In patients with refractory slow transit constipation, SNS did not improve the frequency of complete bowel movements over the 3-week active period.

Cited by 114 publications

References 38 publications

Searching for a definition for pharmacologically refractory constipation: A systematic review

Searching for a definition for pharmacologically refractory constipation: A systematic review

Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders

Long-term outcome of sacral neuromodulation for chronic refractory constipation

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