Abstract
To assess the outcomes of sacral nerve stimulation in adults with chronic constipation. Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence-Based Medicine (2009) level. Seven articles were identified, providing data on outcomes in 375 patients. Length of procedures and length of stay was not reported. Data on harms were inconsistently reported and heterogeneous, making estimates of harm tentative and imprecise. Morbidity rates ranged between 13 and 34%, with overall device removal rate between 8 and 23%. Although inconsistently reported, pooled treatment success was typically 57-87% for patients receiving permanent implants, although there was significant variation between studies. Patient selection was inconsistently documented. No conclusions could be drawn regarding particular phenotypes that responded favourably or unfavourably to sacral nerve stimulation. Evidence supporting sacral nerve stimulation is derived from poor quality studies. Three methodologically robust trials are have reported since this review and all have all urged greater caution.
Highlights
Background and procedural variationsSacral nerve stimulation (SNS) is well established for pelvic urinary indications and for the treatment of faecal incontinence when conservative measures have failed [1,2]
Evidence supporting sacral nerve stimulation is derived from poor quality studies
Three methodologically robust trials are have reported since this review and all have all urged greater caution
Summary
Sacral nerve stimulation (SNS) is well established for pelvic urinary indications and for the treatment of faecal incontinence when conservative measures have failed [1,2]. Its role in the management of chronic constipation (CC) has been studied since 2001 [3], based on a century of experimental (multiple species: physiological and anatomical) and clinical data that the sacral innervation has a prokinetic effect on the rectum and colon via ascending colonic nerves [4]. Brindley stimulation has exploited this effect in small numbers of patients since the 1980s [5,6] and mechanistic studies from Adelaide of SNS effects on transit and colonic contractile activity have confirmed potential to Scope. The purpose of this study was to assess the efficacy and harms of implanted SNS for adult patients whose main presenting complaint is chronic constipation.
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