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Comparative Study
. 2020 Aug;32(8):e13809.
doi: 10.1111/nmo.13809. Epub 2020 Feb 3.

Comparison of antegrade continence enema treatment and sacral nerve stimulation for children with severe functional constipation and fecal incontinence

Mana H Vriesman  1   2 , Lyon Wang  1   3 , Candice Park  1   3 , Karen A Diefenbach  4 , Marc A Levitt  4 , Richard J Wood  4 , Seth A Alpert  5 , Marc A Benninga  2 , Karla Vaz  1 , Desale Yacob  1 , Carlo Di Lorenzo  1 , Peter L Lu  1
Affiliations
Comparative Study

Comparison of antegrade continence enema treatment and sacral nerve stimulation for children with severe functional constipation and fecal incontinence

Mana H Vriesman et al. Neurogastroenterol Motil. 2020 Aug.

Abstract

Background: To compare antegrade continence enema (ACE) treatment and sacral nerve stimulation (SNS) in children with intractable functional constipation (FC) and fecal incontinence (FI).

Methods: We performed a retrospective review of children 6-18 years old with FC and FI treated with either ACE or SNS at our institution. We recorded symptoms at baseline, 6 months, 12 months, 24 months, and their most recent visit after starting treatment. We compared improvement in FI, bowel movement (BM) frequency, abdominal pain, laxative use, and complications. Patients were contacted to evaluate perceived benefit using the Glasgow Children's Benefit Inventory.

Key results: We included 23 patients treated with ACE (52% female, median age 10 years) and 19 patients treated with SNS (74% female, median age 10 years). Improvement in FI was greater with SNS than ACE at 12 months (92.9% vs 57.1%, P = .03) and 24 months (100% vs 57.1%, P = .02). Improvement in BM frequency was greater with ACE, and children were more likely to discontinue laxatives at all follow-up time points (all P < .05). Improvement in abdominal pain was greater with ACE at the most recent visit (P < .05). Rate of complications requiring surgery was similar between groups (26.3% vs 21.7%). Benefit was reported in 83.3% and 100% of ACE and SNS groups, respectively (NS).

Conclusions and inferences: Although both ACE and SNS can lead to durable improvement in children with FC and FI, SNS appears more effective for FI and ACE more effective in improving BM frequency and abdominal pain and in discontinuation of laxatives.

Keywords: antegrade continence enemas; children; functional constipation; neuromodulation; sacral nerve stimulation.

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Conflict of interest statement

The authors have no financial relationships relevant to this article to disclose. The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart inclusion and exclusion of patients
Figure 2
Figure 2
Patients with fecal incontinence at follow‐up. *P < .05. P‐value refers to difference in improvement from baseline. Follow‐up data were available for 41 children at 6 mo after treatment, 35 children at 12 mo, 26 children at 24 mo, and all 42 children at most recent follow‐up
Figure 3
Figure 3
Patients with improvement in defecation frequency at follow‐up. *P < .05. P‐value refers to difference in improvement from baseline. Follow‐up data were available for 41 children at 6 mo after treatment, 35 children at 12 mo, 26 children at 24 mo, and all 42 children at most recent follow‐up
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