Document Detail


Sacral nerve stimulation for intractable constipation.
MedLine Citation:
PMID:  20207638     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Traditional surgical procedures for intractable idiopathic constipation are associated with a variable outcome and substantial morbidity. The symptomatic response, physiological effect and effect on quality of life of sacral nerve stimulation (SNS) were evaluated in patients with constipation (slow transit and normal transit with impaired evacuation). METHODS: In a prospective study at five European sites patients who failed conservative treatment underwent 21 days test stimulation. Patients with >50% improvement in symptoms underwent permanent neurostimulator implantation. Primary end points were increased defecation frequency, decreased straining and decreased sensation of incomplete evacuation. RESULTS: 62 patients (55 female, median age 40 years) underwent test stimulation, of whom 45 (73%) proceeded to chronic stimulation. 39 (87%) of these 45 patients achieved treatment success. After a median 28 (range 1-55) months follow-up, defecation frequency increased from 2.3 to 6.6 evacuations per week (p<0.001). Days per week with evacuation increased from 2.3 to 4.8 (p<0.001). There was a decrease in time spent toileting (10.5 to 5.7 min, p=0.001), straining (75-46% of successful evacuations, p<0.001), perception of incomplete evacuation (71.5-46% of successful evacuations, p<0.001) and subjective rating of abdominal pain and bloating (p<0.001). Cleveland Clinic constipation score (0=no to 30=severe constipation) decreased from 18 to 10 (p<0.001). Visual analogue scale (VAS) score (0=severe to 100=no symptoms) increased from 8 to 66 (p<0.001). Patients with slow and normal transit benefited. Quality of life significantly improved. Colonic transit normalised in half of those with baseline slow transit (p=0.014). CONCLUSION: SNS is effective in the treatment of idiopathic slow and normal transit constipation resistant to conservative treatment. Clinical Trial Number NCT00200005.
Authors:
Michael A Kamm; Thomas C Dudding; Jarno Melenhorst; Michael Jarrett; Zengri Wang; Steen Buntzen; Claes Johansson; Søren Laurberg; Harald Rosen; Carolynne J Vaizey; Klaus Matzel; Cor Baeten
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gut     Volume:  59     ISSN:  1468-3288     ISO Abbreviation:  Gut     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-08     Completed Date:  2010-05-19     Revised Date:  2010-07-22    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  England    
Other Details:
Languages:  eng     Pagination:  333-40     Citation Subset:  AIM; IM    
Affiliation:
University Department of Medicine, St Vincent's Hospital, Victoria Parade, Fitzroy, Melbourne 3065, Australia. mkamm@unimelb.edu.au
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00200005
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Chronic Disease
Constipation / physiopathology,  therapy*
Defecation / physiology
Electric Stimulation Therapy / adverse effects,  methods*
Electrodes, Implanted
Epidemiologic Methods
Female
Gastrointestinal Transit / physiology
Humans
Lumbosacral Plexus / physiopathology*
Male
Middle Aged
Quality of Life
Treatment Outcome
Young Adult
Comments/Corrections
Comment In:
Gut. 2010 Aug;59(8):1156-7; author reply 1157   [PMID:  20587549 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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