Midterm outcomes of injectable bulking agents for fecal incontinence: a systematic review and meta-analysis

Hong, Kwang Dae; Kim, J. S.; Ji, Woong Bae; Um, Jun Won

doi:10.1007/s10151-017-1593-0

Cited by 25 publications

(18 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Analysis of the literature revealed five systematic reviews which assessed the effects of injectable bulking agents versus no injectable bulking agents on FI complaints in the general FI population 76–80 . In total two of the RCTs included in the systematic reviews answer the PICO question by assessing the effects of injectable bulking agents compared to a control (sham).…”

Section: Second Line: Surgical Interventions For Faecal Incontinencementioning

confidence: 99%

“…Conclusion: SNM ON generally results in fewer mean number of weekly FI episodes compared to SNM OFF and compared to conservative treatment (significantly in 3/5 studies, no significance reported in one study and no difference in one study). Severity of FI was also generally less in the SNM group (Significantly less in two-fifths studies, Analysis of the literature revealed five systematic reviews which assessed the effects of injectable bulking agents versus no injectable bulking agents on FI complaints in the general FI population [76][77][78][79][80]. In total two of the RCTs included in the systematic reviews answer the PICO question by assessing the effects of injectable bulking agentscompared to a control (sham).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

et al. 2022

View full text Add to dashboard Cite

Introduction:The goal of this project was to create an up-to-date joint European clinical practice guideline for the diagnosis and treatment of faecal incontinence (FI), using the best available evidence. These guidelines are intended to help guide all medical professionals treating adult patients with FI (e.g., general practitioners, surgeons, gastroenterologists, other healthcare workers) and any patients who are interested in information regarding the diagnosis and management of FI.Methods: These guidelines have been created in cooperation with members from the United European Gastroenterology (UEG), European Society of Coloproctology (ESCP), European Society of Neurogastroenterology and Motility (ESNM) and the European Society for Primary Care Gastroenterology (ESPCG). These members made up the guideline development group (GDG). Additionally, a patient advisory board (PAB) was created to reflect and comment on the draft guidelines from a patient perspective. Relevant review questions were established by the GDG along with a set of outcomes most important for decision making. A systematic literature search was performed using these review questions and outcomes as a framework.For each predefined review question, the study or studies with the highest level of study design were included. If evidence of a higher-level study design was available, no lower level of evidence was sought or included. Data from the studies were extracted by two reviewers for each predefined important outcome within each review question. Where possible, forest plots were created. After summarising the results for each review question, a systematic quality assessment using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach was performed. For each review question, we assessed the quality of evidence for every predetermined important outcome. After evidence review and quality assessment were completed, recommendations could be formulated. The wording used for each recommendation was dependent on the level of quality of evidence. Lower levels of evidence resulted in weaker recommendations and higher levels of evidence resulted in stronger recommendations. Recommendations were discussed within the GDG to reach consensus.Results: These guidelines contain 45 recommendations on the classification, diagnosis and management of FI in adult patients. Conclusion:These multidisciplinary European guidelines provide an up-to-date comprehensive evidence-based framework with recommendations on the diagnosis and management of adult patients who suffer from FI.

show abstract

Section: Second Line: Surgical Interventions For Faecal Incontinencementioning

confidence: 99%

mentioning

confidence: 99%

Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Secondly, as previously stated, FI is a symptom with multiple etiologies indicating that most treated cohorts are heterogenous [2,[5][6][7][8]. Finally, there are at least 11 bulking agents on the market, and site, volume, route and method of injection differ from study to study [9,31]. A 2013 Cochrane review concluded that the quality is poor in most trials, adding to the challenge [12].…”

Section: Discussionmentioning

confidence: 99%

A short- and long-term follow-up study of intersphincteric NASHA Dx implants for fecal incontinence

2022

View full text Add to dashboard Cite

Background The bulking agent NASHA Dx injected into the submucosal layer is effective in the treatment of fecal incontinence (FI) at short-and medium-term follow-up but efficacy after injection in the intersphincteric location is unknown. The aim of this study was to determine the short- and long-term efficacy and safety of NASHA Dx injected into the intersphincteric location for FI. Methods Patients were recruited from referrals to our Department for treatment of FI in November 2008–January 2010. Eligible patients were injected with 8 ml of NASHA Dx. Patients with a subtotal treatment effect were retreated after 2–4 weeks. The change in number of fecal incontinence episodes, the proportion of responders defined as at least 50% decrease in number of FI episodes and side effects were the main outcome measures. Results Sixteen patients, 15 women and 1 man with a median age of 68, 5 (range 44–80) years and a median CCFIS of 15 (range 10–19) were included in the study. The median number of incontinence episodes decreased from 21.5 (range 8–61) at baseline to 10 (range 0–30) at 6 months (p = 0.003) and 6 (range 0–44) at 12 months (p = 0.05). The median number of incontinence episodes in the 11 patients completing the 10-year follow-up was 26.5 (range 0–68). The percentage of responders at 12 months and 10 years were 56% and 27%, respectively. Mild to moderate pain at the injection site was described by 69%. There was one case of mild infection, successfully treated with antibiotics and one implant had to be removed due to dislocation. Conclusions NASHA Dx as an intersphincteric implant improves incontinence symptoms in the short term with moderate side effects and can be used alone or as an adjunct to other treatment modalities. Long-term efficacy was observed in 27%.

show abstract

“…Similarly, some studies have found that manometry findings did not correlate consistently with AI severity; however, manometry findings may influence the management and individual selection of therapeutic strategies. [22][23][24][25][26]…”

Section: Between-group Analysis Of Anorectal Manometry Datamentioning

confidence: 99%

Administration of an Anal Bulking Agent With Polyacrylate-Polyalcohol Copolymer Particles Versus Endoanal Electrical Stimulation With Biofeedback for the Management of Mild and Moderate Anal Incontinence: A Randomized Prospective Study

Neto

Pinto

Brandão

et al. 2022

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

BACKGROUND: There are few treatment options for mild-to-moderate anal incontinence with isolated internal anal sphincter defects or anal incontinence without muscle damage. Less-invasive techniques are generally favored. OBJECTIVE: To compare the results between the use of an anal bulking agent with polyacrylate-polyalcohol copolymer particles and endoanal electrical stimulation with biofeedback in patients with mild or moderate anal incontinence. DESIGN: This was a prospective parallel-group, single-institution, randomized clinical trial. SETTINGS: This study was conducted in an ambulatory setting at the Colorectal Physiology Service of the Hospital das Clinicas, Medical School, University of Sao Paulo. PATIENTS: This study included patients who had anal incontinence for >6 months with isolated internal anal sphincter muscle damage or absence of anatomical defects in the anorectal sphincter complex. INTERVENTIONS: Anal bulking agent and endoanal electrical stimulation with biofeedback. MAIN OUTCOME MEASURES: The primary outcome measure was the Cleveland Clinic Florida Fecal Incontinence Score, and the secondary outcome measures included quality of life, recommended procedures, and anorectal manometry. RESULTS: There were no significant between-group differences in mean age, sex, BMI, stool consistency, and Cleveland Clinic Florida Fecal Incontinence Score (p = 0.20) at baseline. After 12 months, the Cleveland Clinic Florida Fecal Incontinence Score was found to be significantly improved in patients treated with the bulking agent compared to those treated with electrical stimulation (mean, 6.2 vs 9.2; p = 0.002), though the anorectal manometry parameters did not change significantly. The mean anal Cleveland Clinic Florida Fecal Incontinence Score declined by 4.2 points in the bulking agent group compared to a decline of 0.8 in the electrical stimulation group (mean difference in decline: 3.4 points; 95% CI, 1.2–5.5). Quality-of life evaluation showed similar results between groups comparing baseline parameters with 12-month follow-up. LIMITATIONS: The short follow-up period of 1 year, atypical method of biofeedback, and unmatched baseline in some of the quality-of-life scales between the 2 groups limited this study. CONCLUSIONS: In patients with mild or moderate anal incontinence, the Cleveland Clinic Florida Fecal Incontinence Score significantly improved in the bulking agent with polyacrylate-polyalcohol copolymer group compared with the endoanal electrical stimulation with biofeedback group. See Video Abstract at http://links.lww.com/DCR/B938. ADMINISTRACIÓN DE UN GEL ANAL CON PARTÍCULAS DE COPOLÍMERO DE POLIACRILATO-POLIALCOHOL VERSUS ESTIMULACIÓN ELÉCTRICA ENDOANAL CON EJERCICIOS ANALES (Biofeedback) PARA EL MANEJO DE LA INCONTINENCIA ANAL LEVE Y MODERADA: UN ESTUDI PROSPECTIVO ALEATORIZADO ANTECEDENTES: Hasta la fecha, existen pocas opciones de tratamiento para la incontinencia anal de leve a moderada con defectos aislados del esfínter anal interno o la incontinencia anal sin daño muscu...

show abstract

Midterm outcomes of injectable bulking agents for fecal incontinence: a systematic review and meta-analysis

Cited by 25 publications

References 31 publications

Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

A short- and long-term follow-up study of intersphincteric NASHA Dx implants for fecal incontinence

Administration of an Anal Bulking Agent With Polyacrylate-Polyalcohol Copolymer Particles Versus Endoanal Electrical Stimulation With Biofeedback for the Management of Mild and Moderate Anal Incontinence: A Randomized Prospective Study

Contact Info

Product

Resources

About