Abstract
BackgroundThe efficacy of sacral nerve stimulation (SNS) on patients with chronic refractory slow-transit constipation is controversial and its mechanism of action on gastrointestinal motility and transit is not fully understood. The aim of this study was to document the effects of temporary SNS on the gastrointestinal and biliary tract motility and on gastrointestinal transit in patients with refractory slow-transit constipation.MethodsThis was a prospective interventional study. Patients with slow-transit chronic constipation, unresponsive to any conservative treatment, were enrolled between January 2013 and December 2018. Patients’ quality of life [patient assessment of constipation quality of life (PAC-QOL) questionnaire], constipation scores (Cleveland Clinic Constipation Score) colonic transit time (CTT), orocecal transit time (OCTT), gastric and gallbladder kinetics, together with the assessment of the autonomic nerve function were evaluated before and during temporary SNS.Results14 patients (12 females, median age 38 years, range 24–42 years) had temporary SNS. The Cleveland Clinic Constipation Score did not change compared to baseline (23 ± 3 vs 21.4; p = 070). The PAC-QOL did not improve significantly during the stimulation period. Gallbladder/stomach motility (half-emptying time) did not change significantly before and after SNS. OCTT was delayed at baseline, as compared to standard internal normal values, and did not change during SNS. CTT did not improve significantly, although in two patients it decreased substantially from 97 to 53 h, and from 100 to 65 h.ConclusionsTemporary SNS did not have any effect on upper/lower gastrointestinal motility and transit in patients with severe constipation.
Highlights
Sacral nerve stimulation (SNS) is a minimally invasive, reversible and low-risk procedure currently considered an effective and reliable treatment option for patients with urinary and fecal incontinence of various etiologies [1], with positive long-term outcomes [2].sacral nerve stimulation (SNS) improves other pelvic floor dysfunctions such as urinary retention [3], and constipation [4]
We evaluated the potential role of an underlying subclinical autonomic neuropathy (AN) in the response of constipated patients to SNS
Before and during temporary SNS, we evaluated patients’ quality of life (PAC-QOL questionnaire), constipation scores (Cleveland Clinic Constipation Score), gastrointestinal motility, gallbladder and gastric emptying, orocecal transit time (H2-lactulose breath test, OCTT), and colonic transit time ([CTT]radiopaque markers)
Summary
Sacral nerve stimulation (SNS) is a minimally invasive, reversible and low-risk procedure currently considered an effective and reliable treatment option for patients with urinary and fecal incontinence of various etiologies [1], with positive long-term outcomes [2].SNS improves other pelvic floor dysfunctions such as urinary retention [3], and constipation [4]. Slow-transit constipation is often the most relevant clinical expression of a pan-enteric motility disorder involving the whole gastrointestinal (GI) tract and the biliary motor function [15, 16], with potential impact on the outcome of both medical and surgical treatments [17]. The efficacy of sacral nerve stimulation (SNS) on patients with chronic refractory slow-transit constipation is controversial and its mechanism of action on gastrointestinal motility and transit is not fully understood. The aim of this study was to document the effects of temporary SNS on the gastrointestinal and biliary tract motility and on gastrointestinal transit in patients with refractory slow-transit constipation. Conclusions Temporary SNS did not have any effect on upper/lower gastrointestinal motility and transit in patients with severe constipation
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