Meeting News

Nerve stimulation, antegrade enemas both help kids’ constipation

SAN DIEGO — Sacral nerve stimulation and antegrade continence enemas, when compared with each other, both offer positive experiences for children with severe constipation and each may best suit a different cohort of children, a presenter at Digestive Disease Week 2019 said.

“Overall, families in both groups had a highly favorable impression of their procedures. Some described their procedures as life changing and some said they wished they knew about the procedures earlier,” Lyon Wang, BA, MS3, a third-year medical student at The Ohio State University, said during his presentation.

In this prospective comparison of sacral nerve stimulation (SNS) vs. antegrade continence enemas (ACE) for children with severe functional constipation, Wang and colleagues used data from two patient registries for patients receiving SNS and ACE aged younger than 18 years who had functional constipation. Patients completed questionnaires at baseline and follow-up encounters at 6 and 12 months and the researchers used additional information from EMR to fill out the study. Researchers also contacted parents by phone to administer the Glasgow Children’s Benefit Inventory and added two questions directed at the parent.

“Both SNS and ACE can be effective in children with severe functional constipation, but no studies thus far have compared these two options,” Wang said.

The baseline group comprised 31 patients who underwent SNS (65% girls) and 10 who underwent ACE (60% girls). Wang pointed out that, at baseline, the SNS group did have more frequent bowel movements with 23% having three or less BMs per week vs. 60% of the ACE group falling into that category. Similarly, only 10% of the SNS group used rectal enemas at baseline compared with 50% of the ACE group.

Wang and colleagues defined success as three or more BMs per week and less than one fecal incontinence (FI) incident per week.

“We found that patients in the SNS group did not significantly improve their bowel movement frequency, but they did show a significant reduction in fecal incontinence at 6 months (P < .05) and 12 months (P < .01) after initiating treatment,” Wang said. “In contrast, patients in the ACE group showed significant improvement in bowel movement frequency (P < .01 at 6 months; P < .05 at 12 months) but not in fecal incontinence.”

The SNS group also showed reduction in hard stools at both time points (P < .05 for both) while the ACE group did not. Also, the SNS group had higher reports of no abdominal pain at both time points (P < .01 at 6 months; P < .05 at 12 months).

In looking at medication use, Wang reported that the SNS group did not improve in use of oral laxatives or rectal enema use.

“In contrast, the ACE group did show significant improvement in use of oral laxatives at 6 months (P < .01) and 12 months (P < .05) as well as reduction of rectal enema use at 12 months (P < .05),” he said.

“SNS may be a better option for the child with more frequent bowel movements but continued fecal incontinence while ACE may be better for the child with less frequent bowel movements,” Wang said.

The SNS group had fewer total complications – 26% vs. 70% with the ACE group (P < .01) – as well as less major complications requiring surgery (6% vs. 30% with the ACE group; P = .05).

In the follow-up looking to measure patient satisfaction, Wang reported positive results from both groups.

“We found that all patients actually reported a positive benefit from their procedures. ... In terms of satisfaction, nearly all SNS patients would repeat the procedure if given the opportunity and all would recommend the procedure to others,” he said. “In terms of the ACE group, there is universal satisfaction in terms of repeating the procedure and in recommending the procedure to others.” by Katrina Altersitz

Reference: Wang L, et al. Poster 884. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: The authors report no relevant financial disclosures.

SAN DIEGO — Sacral nerve stimulation and antegrade continence enemas, when compared with each other, both offer positive experiences for children with severe constipation and each may best suit a different cohort of children, a presenter at Digestive Disease Week 2019 said.

“Overall, families in both groups had a highly favorable impression of their procedures. Some described their procedures as life changing and some said they wished they knew about the procedures earlier,” Lyon Wang, BA, MS3, a third-year medical student at The Ohio State University, said during his presentation.

In this prospective comparison of sacral nerve stimulation (SNS) vs. antegrade continence enemas (ACE) for children with severe functional constipation, Wang and colleagues used data from two patient registries for patients receiving SNS and ACE aged younger than 18 years who had functional constipation. Patients completed questionnaires at baseline and follow-up encounters at 6 and 12 months and the researchers used additional information from EMR to fill out the study. Researchers also contacted parents by phone to administer the Glasgow Children’s Benefit Inventory and added two questions directed at the parent.

“Both SNS and ACE can be effective in children with severe functional constipation, but no studies thus far have compared these two options,” Wang said.

The baseline group comprised 31 patients who underwent SNS (65% girls) and 10 who underwent ACE (60% girls). Wang pointed out that, at baseline, the SNS group did have more frequent bowel movements with 23% having three or less BMs per week vs. 60% of the ACE group falling into that category. Similarly, only 10% of the SNS group used rectal enemas at baseline compared with 50% of the ACE group.

Wang and colleagues defined success as three or more BMs per week and less than one fecal incontinence (FI) incident per week.

“We found that patients in the SNS group did not significantly improve their bowel movement frequency, but they did show a significant reduction in fecal incontinence at 6 months (P < .05) and 12 months (P < .01) after initiating treatment,” Wang said. “In contrast, patients in the ACE group showed significant improvement in bowel movement frequency (P < .01 at 6 months; P < .05 at 12 months) but not in fecal incontinence.”

The SNS group also showed reduction in hard stools at both time points (P < .05 for both) while the ACE group did not. Also, the SNS group had higher reports of no abdominal pain at both time points (P < .01 at 6 months; P < .05 at 12 months).

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In looking at medication use, Wang reported that the SNS group did not improve in use of oral laxatives or rectal enema use.

“In contrast, the ACE group did show significant improvement in use of oral laxatives at 6 months (P < .01) and 12 months (P < .05) as well as reduction of rectal enema use at 12 months (P < .05),” he said.

“SNS may be a better option for the child with more frequent bowel movements but continued fecal incontinence while ACE may be better for the child with less frequent bowel movements,” Wang said.

The SNS group had fewer total complications – 26% vs. 70% with the ACE group (P < .01) – as well as less major complications requiring surgery (6% vs. 30% with the ACE group; P = .05).

In the follow-up looking to measure patient satisfaction, Wang reported positive results from both groups.

“We found that all patients actually reported a positive benefit from their procedures. ... In terms of satisfaction, nearly all SNS patients would repeat the procedure if given the opportunity and all would recommend the procedure to others,” he said. “In terms of the ACE group, there is universal satisfaction in terms of repeating the procedure and in recommending the procedure to others.” by Katrina Altersitz

Reference: Wang L, et al. Poster 884. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: The authors report no relevant financial disclosures.

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