Effects of temporary sacral nerve stimulation on gastrointestinal motility and function in patients with chronic refract
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ORIGINAL ARTICLE
Effects of temporary sacral nerve stimulation on gastrointestinal motility and function in patients with chronic refractory slow‑transit constipation D. F. Altomare1,3 · A. Picciariello1 · A. Di Ciaula2 · M. Rinaldi1 · M. De Fazio1 · P. Portincasa2 Received: 2 July 2020 / Accepted: 23 October 2020 © The Author(s) 2020
Abstract Background 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. Methods This 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. Results 14 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. Conclusions Temporary SNS did not have any effect on upper/lower gastrointestinal motility and transit in patients with severe constipation. Keywords Chronic slow-transit constipation · Sacral nerve stimulation · Gastrointestinal motility · Autonomic nerve function
Introduction
* D. F. Altomare [email protected] * P. Portincasa [email protected] 1
Department of Emergency and Organ Transplantation, University “Aldo Moro”, Bari, Italy
2
Department of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University “Aldo Moro”, Bari, Italy
3
IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
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 also improves other pelvic floor dysfunctions such as urinary retention [3], and constipation [4]. In particular, studies suggest improvement in constipation symptoms after SNS in both slo
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