Sacral nerve stimulation for faecal incontinence and constipation: a European consensus statement.

Area of Science:

• Gastroenterology and Urology
• Neuromodulation Therapies
• Clinical Practice Guidelines

Background:

• Sacral nerve stimulation (SNS), also known as sacral neuromodulation (SNM), is increasingly used in Europe for treating fecal incontinence (FI) and constipation.
• A lack of consensus exists regarding optimal baseline investigations, patient selection criteria, and surgical techniques for SNS/SNM.
• This study aimed to establish consensus on the current practices of SNS/SNM for FI and constipation.

Framework:

• A modified Delphi process was employed to achieve expert consensus.
• A systematic literature search was conducted using PubMed to identify relevant studies on SNS for FI and constipation.
• An international panel of 22 European specialists in FI and constipation participated.

Implementation:

• Experts answered a set of questions online over two separate occasions.
• A face-to-face meeting was held to finalize discussions and reach agreement.
• The process involved a literature search, online questionnaires, and an in-person expert meeting.

Implications:

• High agreement (86% across 50 domains) was achieved on key aspects including service setup, patient selection, investigations, operative techniques, and device programming.
• The median agreement level was 95%, indicating strong consensus among specialists.
• The established consensus provides a benchmark for safe and quality practice of SNS/SNM in Europe.