BACKGROUND: Sacral nerve stimulation (SNS) has proven short- to medium-term effectiveness for the treatment of faecal incontinence (FI); fewer long-term outcomes have been presented and usually in small series. Here, the long-term effectiveness of SNS was evaluated in a large European cohort of patients with a minimum of 5 years' follow-up. METHODS: Prospectively registered data from patients with FI who had received SNS for at least 5 years from ten European centres were collated by survey. Daily stool diaries, and Cleveland Clinic and St Mark's incontinence scores were evaluated at baseline, after implantation and at the last follow-up. SNS was considered successful when at least 50 per cent symptom improvement was maintained at last follow-up. RESULTS: A total of 407 patients underwent temporary stimulation, of whom 272 (66·8 per cent) had an impulse generator implanted; 228 (56·0 per cent) were available for long-term follow-up at a median of 84 (i.q.r. 70-113) months. Significant reductions in the number of FI episodes per week (from median 7 to 0·25) and summative symptom scores (median Cleveland Clinic score from 16 to 7, St Mark's score from 19 to 6) were recorded after implantation (all P < 0·001) and maintained in long-term follow-up. In per-protocol analysis, long-term success was maintained in 71·3 per cent of patients and full continence was achieved in 50·0 per cent; respective values based on intention-to-treat analysis were 47·7 and 33·4 per cent. Predictive analyses determined no significant association between pretreatment variables and successful outcomes. Risk of long-term failure correlated with minor symptom score improvement during the temporary test phase. CONCLUSION: SNS remains an effective treatment for FI in the long term for approximately half of the patients starting therapy.
BACKGROUND: Sacral nerve stimulation (SNS) has proven short- to medium-term effectiveness for the treatment of faecal incontinence (FI); fewer long-term outcomes have been presented and usually in small series. Here, the long-term effectiveness of SNS was evaluated in a large European cohort of patients with a minimum of 5 years' follow-up. METHODS: Prospectively registered data from patients with FI who had received SNS for at least 5 years from ten European centres were collated by survey. Daily stool diaries, and Cleveland Clinic and St Mark's incontinence scores were evaluated at baseline, after implantation and at the last follow-up. SNS was considered successful when at least 50 per cent symptom improvement was maintained at last follow-up. RESULTS: A total of 407 patients underwent temporary stimulation, of whom 272 (66·8 per cent) had an impulse generator implanted; 228 (56·0 per cent) were available for long-term follow-up at a median of 84 (i.q.r. 70-113) months. Significant reductions in the number of FI episodes per week (from median 7 to 0·25) and summative symptom scores (median Cleveland Clinic score from 16 to 7, St Mark's score from 19 to 6) were recorded after implantation (all P < 0·001) and maintained in long-term follow-up. In per-protocol analysis, long-term success was maintained in 71·3 per cent of patients and full continence was achieved in 50·0 per cent; respective values based on intention-to-treat analysis were 47·7 and 33·4 per cent. Predictive analyses determined no significant association between pretreatment variables and successful outcomes. Risk of long-term failure correlated with minor symptom score improvement during the temporary test phase. CONCLUSION: SNS remains an effective treatment for FI in the long term for approximately half of the patients starting therapy.
Authors: L Oliveira; G Hagerman; M L Torres; C M Lumi; J A C Siachoque; J C Reyes; J Perez-Aguirre; J C Sanchez-Robles; V H Guerrero-Guerrero; S M Regadas; V G Filho; G Rosato; E Vieira; L Marzan; D Lima; E Londoño-Schimmer; S D Wexner Journal: Tech Coloproctol Date: 2019-06-12 Impact factor: 3.781
Authors: Zhihui Huang; Shiying Li; Robert D Foreman; Jieyun Yin; Ning Dai; Jiande D Z Chen Journal: Am J Physiol Gastrointest Liver Physiol Date: 2019-08-14 Impact factor: 4.052
Authors: David G Jayne; Annabelle E Williams; Neil Corrigan; Julie Croft; Alison Pullan; Vicky Napp; Rachel Kelly; David Meads; Armando Vargas-Palacios; Adam Martin; Claire Hulme; Steven R Brown; Karen Nugent; Jen Lodge; David Protheroe; Sushil Maslekar; Andrew Clarke; Pasha Nisar; Julia M Brown Journal: Health Technol Assess Date: 2021-03 Impact factor: 4.014
Authors: Jakob Duelund-Jakobsen; Jonas Worsoe; Lilli Lundby; Peter Christensen; Klaus Krogh Journal: Therap Adv Gastroenterol Date: 2016-01 Impact factor: 4.409
Authors: L Lagares-Tena; L Millán-Paredes; L Lázaro-García; A Navarro-Luna; S Delgado-Rivilla; A Muñoz-Duyos Journal: Tech Coloproctol Date: 2018-01-16 Impact factor: 3.781