Long-term results following sacral nerve stimulation for chronic constipation

Area of Science:

• Gastroenterology
• Neurology
• Urology

Background:

• Chronic functional constipation is a debilitating condition impacting quality of life.
• Sacral nerve stimulation (SNS) is a neuromodulation therapy used for refractory constipation.
• Long-term outcomes of SNS for specific constipation subtypes are not well-established.

Purpose of the Study:

• To assess the long-term efficacy and outcomes of sacral nerve stimulation (SNS) in patients with chronic functional constipation.
• To differentiate the response to SNS based on the pathophysiological subtype of constipation: slow transit constipation (STC), obstructed defecation (OD), and mixed/undetermined (MU).

Main Methods:

• A prospective study included patients with chronic functional constipation who received a definitive SNS implant.
• Patients were followed for at least 3 years, with data collected on constipation severity (Cleveland Clinic Constipation score - CCCS) and quality of life (SF-36).
• Physiological tests were performed to categorize patients into STC, OD, or MU subtypes.

Main Results:

• Following SNS implantation (mean follow-up 51 months), the CCCS significantly decreased from 17 to 9 (P < 0.001).
• 47% of patients experienced a >50% improvement in CCCS, with greater efficacy observed in patients with OD.
• SF-36 scores significantly improved across all domains, particularly in the OD group, while anal pressures remained unchanged.

Conclusions:

• Sacral nerve stimulation (SNS) demonstrates prolonged clinical efficacy in managing chronic functional constipation.
• Patient selection is crucial, with obstructed defecation (OD) subtypes showing a more robust and significant response to SNS compared to slow transit constipation (STC).
• SNS can lead to significant improvements in symptom severity and health-related quality of life for selected constipated patients.