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Anorectal Physiology Testing in Asymptomatic™ Obstetric Anal Sphincter Injury (OASIS)
AGA Abstracts
respectively. Unpaired t test was also used to compare changes from baseline at 3 years between the treatment groups. Results: In the whole patient group, persistent increases in LENT-SOMA symptom scores of frequency of defaecation (p<0.05), diarrhoea (p<0.01), rectal pain (p<0.05), mucous discharge (p<0.01) and rectal bleeding (p<0.001) over 3 years were associated with decreases in anorectal motor function (basal anal pressures and responses to increased intra-abdominal pressure (p<0.01 for both)), reductions in threshold volumes for sensory perception and rectal compliance (p<0.05 for both) and reduced thickness of both the internal and external anal sphincters (p<0.05 and p<0.001, respectively). EORTC QLQ-PR25 bowel and urinary symptom (p<0.01 for both) scores worsened over 3 years. IGRT+ERB reduced (i) LENT-SOMA rectal bleeding scores (Figure 1), (ii) prevalence of impaired anorectal sensory function (p<0.05) and (iii) prevalence of decreased global health status (p<0.05) compared to IGRT-ERB at 3 years. Conclusion: 3 years after IGRT for CaP, anorectal dysfunction with impairment of bowel and urinary HRQoL measures persists in the whole patient group. IGRT+ERB reduces rectal bleeding and rectal hypersensitivity and improves global health HRQoL symptom scores compared with IGRT-ERB. 1Resnick et al, N Engl J Med 2013; 368(5):436-445, 2Smeenk et al, Radiother Oncol 2009; 93:131-136, 3 Yeoh et al, Int J Radiat Oncol 2012; 84:e593-e599, 4Botten et al, Gastroenterology 2016; 150(4):S937
Method: Women referred for ARM to guide future obstetric management following OASIS over a 10-year period were studied. Only women thought to be asymptomatic for FI on referral were included. All patients completed pre-procedure questionnaires: obstetric history, Rome, incontinence, and the Hospital Anxiety and Depression scale (HAD). Results: 204 ‘asymptomatic' post-partum women (mean age 32 years, SD 3.8, 90% primiparous) with OASIS were included in the study. Most were referred by Obstetricians (98%) and mean time from delivery was 202 (SD 194). Thirteen (8%) of women reported solid FI, 37 (22%) reported liquid FI and 71 (36%) reported flatus incontinence on the pre-procedure questionnaires. The prevalence of other functional gastrointestinal disorders was low (table 1). 19% of women had a hard stool form (Bristol type 1 or 2) despite 12% laxative use. Physiology and obstetric characteristics are shown in table 1. Solid FI and flatus incontinence were both associated with higher birth weight of baby (p=0.02). Women with solid FI were more likely to have undergone induction (81 vs. 45%, p=0.03). Rome FI was associated with a higher percentage of women who underwent episiotomy (38 vs. 19%, p-0.048). A higher degree of tear was associated with lower anal resting pressure (p=0.013) and showed a trend for lower squeeze pressure (p=0.057). Women with either fecal or flatus incontinence compared to truly asymptomatic patients had higher birth weight of baby, lower anal resting pressures and shorter balloon expulsion time (table 2). Conclusion: Our novel study in a large cohort of OASIS patients thought to be asymptomatic shows that flatus incontinence and FI are ‘unvoiced' symptoms and specific questionnaires aimed to detect the full extent of symptoms should be utilised. Even in this cohort thought to be initially asymptomatic, there were correlations between obstetric factors and anorectal physiology, especially resting anal sphincter pressure, emphasizing the importance of this parameter. Table 1: Baseline characteristics, associated gastrointestinal symptoms, obstetric factors and anorectal parameters in 204 post-partum women with obstetric anal sphincter injury who underwent anorectal manometry
Figure 1. LENT-SOMA Rectal Bleeding Scores for IGRT+ERB
Sa1629 SHELF LIFE OF ENGINEERED AUTOLOGOUS BIOSPHINCTERS FOR TREATMENT OF FECAL INCONTINENCE Prabhash Dadhich, Elie Zakhem, Khalil N. Bitar Background: Fecal incontinence is a devastating condition that results from loss of the internal anal sphincter (IAS) integrity and function. Our lab has previously engineered IAS BioSphincters and demonstrated restoration of native sphincter function following their implantation in a rabbit model of fecal incontinence. The shelf-life of a developed product is an important criterion for clinical application under Good Laboratory and Good Manufacturing conditions (GLP/GMP). Objective: The objective of the study was to evaluate the shelf-life of engineered BioSphincters as clinical products for treatment of patients with fecal incontinence. Methods: BioSphincters were engineered using IAS smooth muscle cells and neural progenitor cells (NPCs) obtained from biopsies from rabbits. BioSphincters were characterized daily from day 10 post-engineering up to day 16: (1) Volume and surface area were measured at every time point. (2) Tensile strength and maximum extension were evaluated using an instron machine. (3) Cell viability and homogeneity were determined at each time point. (4) Cell phenotype and differentiation were compared at different time points using qPCR. (5) Real time force generation was conducted on the BioSphincters at the different time points. One way ANOVA was used to compare the results at different time points. Results: (1) The volume of the BioSphincters averaged 20.35 ± 0.03 mm3 at day 10 and 20.64 ± 0.01 mm3 at day 16. Surface area averaged 33.2 ± 0.03 mm2 at day 10 and 33.62 ± 0.01 mm2 at day 16. (2) There was no significant change in the tensile strength and extension of the BioSphincters between day 10 and day 16. These results indicated the maintenance of the consistency of the BioSphincters over 7 days post-maturation without degradation. (3) Viability assay showed no significant decrease in the cell number in the BioSphincters over 7 days, indicating the maintenance of the BioSphincters bioactivity. (4) qPCR revealed the maintenance of the expression of mature smooth muscle phenotype over 7 days. Highest expression of βIII tubulin started at day 10 and was maintained over 7 days indicating complete differentiation of NPCs. (5) The BioSphincters generated force to a similar extent in response to acetylcholine (312 ± 23.4 µN at day 10 and 308 ± 8.8 µN at day 16). Electrical field stimulation-(EFS) induced relaxation averaged -442.5 ± 17.5 µN at day 10 and -315 ± 3.5 µN at day 16. Conclusion: The shelf life of a clinical product is an important criterion for testing the stability and function of the product. The structural, mechanical and physiological properties of the BioSphincters were maintained over 7 days post-maturation, from day 10 to day 16 post-manufacturing. This time span could be considered as implantation window for engineered autologous BioSphincters. This work was supported by NIH/NIDDK R42DK10559.
Sa1630 ANORECTAL PHYSIOLOGY TESTING IN ASYMPTOMATIC™ OBSTETRIC ANAL SPHINCTER INJURY (OASIS) Christine Verdon, Yoav Mazor, Gillian Prott, Anastasia Ejova, Michael P. Jones, John Kellow, Allison Malcolm Background: Anal sphincter dysfunction related to pregnancy and childbirth leads to fecal incontinence (FI) in a substantial number of post-partum women (25% at 6 months) (1). Cesarean section for subsequent deliveries is often advised in those with symptomatic FI, but the management of those without symptoms is more controversial. Some centers perform limited anorectal manometry (ARM) to guide such decision-making, but the clinical utility of test results is unclear. Aim: To describe a cohort of post-partum women with obstetric anal sphincter injury (OASIS), who were thought to be asymptomatic on referral, in terms of their gastrointestinal symptoms and comprehensive anorectal physiology testing. Patients &
AGA Abstracts
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same protocol: resting period of 2 minutes, 2 voluntary squeeze of 5 seconds and 1 sustained voluntary squeeze of more than 20 seconds, and 1 cough maneuver. Push maneuvers were also performed but not analyzed in this study. The severity of symptoms was measured by the Jorge and Wexner score (JWS) for FI, and by the KESS score for CC. The following 3DARM variables were studied: mean anal resting pressure, maximal pressure during short squeeze, maximal and mean pressure during sustained squeeze, maximal duration of sustained squeeze, maximal anal pressure during the cough maneuver, incremental (squeeze rest) anal pressures, presence of ultra-slow waves, and asymmetrical lambda aspect of 3D pressures during squeeze. The ability of these variables to distinguish FI patients from CC patients was studied by logistic regression and comparison of areas under the curve (AUC) of Receiver Operating Characteristic (ROC) curves for quantitative data, and by sensitivity and specificity for qualitative ones. Results. All pressure variables were highly correlated (p<0.0001). The most discriminant variable between FI and CC groups was the mean anal pressure during 20 seconds of sustained squeeze (AUC: 0.831). The association of several variables was not more discriminant than this single sustained squeeze value. The absence of the lambda pattern during squeeze was similarly frequent in both groups (sensitivity for the diagnosis of FI: 0.771, specificity: 0.127). Ultras-slow waves were found in 20% of the CC patients, and in none of the FI patients. Among patients with FI, anal pressures at rest, during squeeze and during the cough maneuver were all significantly correlated to the JWS (p<0.0001).Among CC patients, there was no correlation between the KESS score and any 3DARM variables. Conclusion 3DARM variables used to study anal sphincter function appeared very dependent and correlated. The most discriminant variable between FI and CC patients was the mean anal pressure during sustained squeeze. These observations should facilitate the standardization of protocol and results obtained with 3DARM.
*Weight was also higher in patients with gas incontinence only as compared to asymptomatic (3600 grams vs. 3430, p=0.04)
Sa1631 LONG TERM RESULTS OF SACRAL NERVE STIMULATION TO TREAT FECAL INCONTINENCE WITHIN A MONOCENTRIC COHORT Henri Damon, Xavier Barth, Sabine Roman, Aurelien Garros, Francois Mion Sacral nerve stimulation (SNS) is a validated therapy for severe fecal incontinence (FI). However, long term results are scares in the literature. The goal of this study was to report long term results of SNS in a monocentric cohort of patients implanted for FI. Patients and methods 207 patients (mean age: 60.5 years (range: 24-84); 196 women) with severe fecal incontinence underwent a SNS test between January 2004 and December 2015. 176 cases (85%) had a stimulator implanted after a positive SNS test. 7 patients were lost of followup, and a follow-up of more than 5 years was complete in 60 cases (mean age 59 years, range: 29-76 years), whose results are reported here. The severity of FI was assessed by the FI Jorge and Wexner score (JWS), and the quality of life with the GIQLI scale. A subjective evaluation of the efficacy of the treatment was performed using a patient-reported numerical scale ranging from -5 (severe aggravation of symptoms) to +5 (excellent result). Associated symptoms were also evaluated according to the KESS questionnaire (constipation), the UDI6 questionnaire (urinary incontinence), and the HAD scale (anxiety and depression). Results were expressed as mean (SD), and comparisons performed by ANOVA or Chi2 test as appropriate. Results The median follow-up was 93 months (range: 60-171 months). There was a significant improvement of the JWS (8(1)/20 vs 14 (1)/20, p<0.0001) and the GIQLI (91 (3) vs 73 (3), p<0.0001) at the last point of follow-up compared to before SNS. Similarly, constipation score was improved (KESS: 13(1) vs 16(2), p=0.04), as well as UD6 (1.7(0.4) vs 2.1 (0.2), p=0.04), and anxiety score (9 (1) vs 11 (1), p=0.04). According to the numerical scale of subjective evaluation of the therapy, 36 patients (60%) reported a significant improvement (scale >+2), 5 (8%) a slight improvement (scale +1 or +2) and 19 (32%) reported no improvement (16 cases, scale=0) or a worsening of their condition (scale <0). Conclusion Results of SNS for FI appeared to maintain in the long term, with 60% of patients remaining satisfied with the technique more than 5 years after permanent implantation. Symptoms of FI are significantly decreased, as well as associated constipation and UI symptoms. Quality of life is improved, as well as anxiety status.
Sa1633 RISK FACTORS FOR FECAL INCONTINENCE IN PATIENTS WITH CROHN'S DISEASE Paul F. Vollebregt, Arjan Visscher, Adriaan A. van Bodegraven, R.J.F. Felt-Bersma Background and aim: Fecal incontinence (FI) has a great impact on daily (quality of) life and many patients are too embarrassed to report it spontaneously. Prevalence of FI in patients with Crohn's disease (CD) has barely been studied and little is known about factors predicting FI in these patients. To estimate its prevalence and evaluate potential causes in patients with complex CD, we studied a tertiary CD population and related outcome with quality of life. Methods: Consecutive patients with CD treated between 2003 and July 2013 at our center were identified in the prospectively maintained departments' IBD-database. A questionnaire was sent out in October 2013 to evaluate current complaints of FI, perianal disease and the Faecal Incontinence Quality of Life questionnaire. Demographic characteristics and medical history were collected by use of the IBD-database and additional chart review. Multivariate regression analysis was performed. Results: The questionnaire was responded by 325 out of 528 patients (62%). Median age of patients was 42 years (range 18-91), 215 (66%) were female and diagnosis of CD was established for a median period of 12 years (interquartile range 6-21). FI was reported by 65 patients (20%), median Cleveland Clinic Incontinence score was 12. FI was associated with liquid stools (p = 0.0001), previously performed IBD-related bowel resections (p = 0.001), stricturing behaviour of disease (p = 0.02) and perianal disease (p = 0.03). Quality of life (lifestyle, coping, depression, embarrassment) was poor in patients with FI, particularly in patients with more frequent episodes of incontinence. Conclusions: Prevalence of FI in a tertiary CD population is substantially higher than in the community-dwelling population. Considering the reduced quality of life in incontinent patients, active questioning to identify FI is recommended in those with liquid stools, perianal disease or previous (intestinal or perianal) surgery. Multimodality treatment is proposed due to the high impact on quality of life.
Sa1632 ANAL SPHINCTER FUNCTION EVALUATED BY 3D HIGH DEFINITION ANORECTAL MANOMETRY IN FECAL INCONTINENCE AND CHRONIC CONSTIPATION PATIENTS Francois Mion, Aurelien Garros, Henri Damon, Sabine Roman
Sa1634 RECTAL ENDOSCOPIC MUCOSAL RESECTION IS SUPERIOR TO RECTAL SUCTION BIOPSY FOR ANALYSIS OF ENTERIC GANGLIA IN CONSTIPATION AND GI DYSMOTILITY Kenneth Barshop, Field F. Willingham, William R. Brugge, Braden Kuo
Introduction 3D high definition anorectal manometry (3DARM) has been recently developed and commercialized, and reference values have been defined. However, the impact of this technique on the diagnostic workup of patients complaining of fecal incontinence (FI) or chronic constipation (CC) has not been assessed. The goal of this study was to analyze the various 3DARM variables describing anal sphincter function, and to test their ability to distinguish patients with FI from those with CC. Patients and methods. 114 consecutive patients (97 women, mean age: 55 years (range: 18-83)) seen in our lab because of FI (35 patients) or CC (79 patients) underwent 3DARM (rigid probe from Medtronic) with the
Background and aim: Adult and pediatric patients presenting with chronic constipation or motility disorders may be referred for rectal suction biopsy to rule out aganglionosis or Hirschsprung's disease (HD). This traditional diagnostic test, rectal suction biopsy (RSB), is a blind technique and may not be successful beyond infancy due to the increased thickness
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AGA Abstracts
AGA Abstracts
Table 2. Clinical and obstetric characteristics and anorectal physiology in women with and without anal incontinence.
respectively. Unpaired t test was also used to compare changes from baseline at 3 years between the treatment groups. Results: In the whole patient group, persistent increases in LENT-SOMA symptom scores of frequency of defaecation (p<0.05), diarrhoea (p<0.01), rectal pain (p<0.05), mucous discharge (p<0.01) and rectal bleeding (p<0.001) over 3 years were associated with decreases in anorectal motor function (basal anal pressures and responses to increased intra-abdominal pressure (p<0.01 for both)), reductions in threshold volumes for sensory perception and rectal compliance (p<0.05 for both) and reduced thickness of both the internal and external anal sphincters (p<0.05 and p<0.001, respectively). EORTC QLQ-PR25 bowel and urinary symptom (p<0.01 for both) scores worsened over 3 years. IGRT+ERB reduced (i) LENT-SOMA rectal bleeding scores (Figure 1), (ii) prevalence of impaired anorectal sensory function (p<0.05) and (iii) prevalence of decreased global health status (p<0.05) compared to IGRT-ERB at 3 years. Conclusion: 3 years after IGRT for CaP, anorectal dysfunction with impairment of bowel and urinary HRQoL measures persists in the whole patient group. IGRT+ERB reduces rectal bleeding and rectal hypersensitivity and improves global health HRQoL symptom scores compared with IGRT-ERB. 1Resnick et al, N Engl J Med 2013; 368(5):436-445, 2Smeenk et al, Radiother Oncol 2009; 93:131-136, 3 Yeoh et al, Int J Radiat Oncol 2012; 84:e593-e599, 4Botten et al, Gastroenterology 2016; 150(4):S937
Method: Women referred for ARM to guide future obstetric management following OASIS over a 10-year period were studied. Only women thought to be asymptomatic for FI on referral were included. All patients completed pre-procedure questionnaires: obstetric history, Rome, incontinence, and the Hospital Anxiety and Depression scale (HAD). Results: 204 ‘asymptomatic' post-partum women (mean age 32 years, SD 3.8, 90% primiparous) with OASIS were included in the study. Most were referred by Obstetricians (98%) and mean time from delivery was 202 (SD 194). Thirteen (8%) of women reported solid FI, 37 (22%) reported liquid FI and 71 (36%) reported flatus incontinence on the pre-procedure questionnaires. The prevalence of other functional gastrointestinal disorders was low (table 1). 19% of women had a hard stool form (Bristol type 1 or 2) despite 12% laxative use. Physiology and obstetric characteristics are shown in table 1. Solid FI and flatus incontinence were both associated with higher birth weight of baby (p=0.02). Women with solid FI were more likely to have undergone induction (81 vs. 45%, p=0.03). Rome FI was associated with a higher percentage of women who underwent episiotomy (38 vs. 19%, p-0.048). A higher degree of tear was associated with lower anal resting pressure (p=0.013) and showed a trend for lower squeeze pressure (p=0.057). Women with either fecal or flatus incontinence compared to truly asymptomatic patients had higher birth weight of baby, lower anal resting pressures and shorter balloon expulsion time (table 2). Conclusion: Our novel study in a large cohort of OASIS patients thought to be asymptomatic shows that flatus incontinence and FI are ‘unvoiced' symptoms and specific questionnaires aimed to detect the full extent of symptoms should be utilised. Even in this cohort thought to be initially asymptomatic, there were correlations between obstetric factors and anorectal physiology, especially resting anal sphincter pressure, emphasizing the importance of this parameter. Table 1: Baseline characteristics, associated gastrointestinal symptoms, obstetric factors and anorectal parameters in 204 post-partum women with obstetric anal sphincter injury who underwent anorectal manometry
Figure 1. LENT-SOMA Rectal Bleeding Scores for IGRT+ERB
Sa1629 SHELF LIFE OF ENGINEERED AUTOLOGOUS BIOSPHINCTERS FOR TREATMENT OF FECAL INCONTINENCE Prabhash Dadhich, Elie Zakhem, Khalil N. Bitar Background: Fecal incontinence is a devastating condition that results from loss of the internal anal sphincter (IAS) integrity and function. Our lab has previously engineered IAS BioSphincters and demonstrated restoration of native sphincter function following their implantation in a rabbit model of fecal incontinence. The shelf-life of a developed product is an important criterion for clinical application under Good Laboratory and Good Manufacturing conditions (GLP/GMP). Objective: The objective of the study was to evaluate the shelf-life of engineered BioSphincters as clinical products for treatment of patients with fecal incontinence. Methods: BioSphincters were engineered using IAS smooth muscle cells and neural progenitor cells (NPCs) obtained from biopsies from rabbits. BioSphincters were characterized daily from day 10 post-engineering up to day 16: (1) Volume and surface area were measured at every time point. (2) Tensile strength and maximum extension were evaluated using an instron machine. (3) Cell viability and homogeneity were determined at each time point. (4) Cell phenotype and differentiation were compared at different time points using qPCR. (5) Real time force generation was conducted on the BioSphincters at the different time points. One way ANOVA was used to compare the results at different time points. Results: (1) The volume of the BioSphincters averaged 20.35 ± 0.03 mm3 at day 10 and 20.64 ± 0.01 mm3 at day 16. Surface area averaged 33.2 ± 0.03 mm2 at day 10 and 33.62 ± 0.01 mm2 at day 16. (2) There was no significant change in the tensile strength and extension of the BioSphincters between day 10 and day 16. These results indicated the maintenance of the consistency of the BioSphincters over 7 days post-maturation without degradation. (3) Viability assay showed no significant decrease in the cell number in the BioSphincters over 7 days, indicating the maintenance of the BioSphincters bioactivity. (4) qPCR revealed the maintenance of the expression of mature smooth muscle phenotype over 7 days. Highest expression of βIII tubulin started at day 10 and was maintained over 7 days indicating complete differentiation of NPCs. (5) The BioSphincters generated force to a similar extent in response to acetylcholine (312 ± 23.4 µN at day 10 and 308 ± 8.8 µN at day 16). Electrical field stimulation-(EFS) induced relaxation averaged -442.5 ± 17.5 µN at day 10 and -315 ± 3.5 µN at day 16. Conclusion: The shelf life of a clinical product is an important criterion for testing the stability and function of the product. The structural, mechanical and physiological properties of the BioSphincters were maintained over 7 days post-maturation, from day 10 to day 16 post-manufacturing. This time span could be considered as implantation window for engineered autologous BioSphincters. This work was supported by NIH/NIDDK R42DK10559.
Sa1630 ANORECTAL PHYSIOLOGY TESTING IN ASYMPTOMATIC™ OBSTETRIC ANAL SPHINCTER INJURY (OASIS) Christine Verdon, Yoav Mazor, Gillian Prott, Anastasia Ejova, Michael P. Jones, John Kellow, Allison Malcolm Background: Anal sphincter dysfunction related to pregnancy and childbirth leads to fecal incontinence (FI) in a substantial number of post-partum women (25% at 6 months) (1). Cesarean section for subsequent deliveries is often advised in those with symptomatic FI, but the management of those without symptoms is more controversial. Some centers perform limited anorectal manometry (ARM) to guide such decision-making, but the clinical utility of test results is unclear. Aim: To describe a cohort of post-partum women with obstetric anal sphincter injury (OASIS), who were thought to be asymptomatic on referral, in terms of their gastrointestinal symptoms and comprehensive anorectal physiology testing. Patients &
AGA Abstracts
S-312
same protocol: resting period of 2 minutes, 2 voluntary squeeze of 5 seconds and 1 sustained voluntary squeeze of more than 20 seconds, and 1 cough maneuver. Push maneuvers were also performed but not analyzed in this study. The severity of symptoms was measured by the Jorge and Wexner score (JWS) for FI, and by the KESS score for CC. The following 3DARM variables were studied: mean anal resting pressure, maximal pressure during short squeeze, maximal and mean pressure during sustained squeeze, maximal duration of sustained squeeze, maximal anal pressure during the cough maneuver, incremental (squeeze rest) anal pressures, presence of ultra-slow waves, and asymmetrical lambda aspect of 3D pressures during squeeze. The ability of these variables to distinguish FI patients from CC patients was studied by logistic regression and comparison of areas under the curve (AUC) of Receiver Operating Characteristic (ROC) curves for quantitative data, and by sensitivity and specificity for qualitative ones. Results. All pressure variables were highly correlated (p<0.0001). The most discriminant variable between FI and CC groups was the mean anal pressure during 20 seconds of sustained squeeze (AUC: 0.831). The association of several variables was not more discriminant than this single sustained squeeze value. The absence of the lambda pattern during squeeze was similarly frequent in both groups (sensitivity for the diagnosis of FI: 0.771, specificity: 0.127). Ultras-slow waves were found in 20% of the CC patients, and in none of the FI patients. Among patients with FI, anal pressures at rest, during squeeze and during the cough maneuver were all significantly correlated to the JWS (p<0.0001).Among CC patients, there was no correlation between the KESS score and any 3DARM variables. Conclusion 3DARM variables used to study anal sphincter function appeared very dependent and correlated. The most discriminant variable between FI and CC patients was the mean anal pressure during sustained squeeze. These observations should facilitate the standardization of protocol and results obtained with 3DARM.
*Weight was also higher in patients with gas incontinence only as compared to asymptomatic (3600 grams vs. 3430, p=0.04)
Sa1631 LONG TERM RESULTS OF SACRAL NERVE STIMULATION TO TREAT FECAL INCONTINENCE WITHIN A MONOCENTRIC COHORT Henri Damon, Xavier Barth, Sabine Roman, Aurelien Garros, Francois Mion Sacral nerve stimulation (SNS) is a validated therapy for severe fecal incontinence (FI). However, long term results are scares in the literature. The goal of this study was to report long term results of SNS in a monocentric cohort of patients implanted for FI. Patients and methods 207 patients (mean age: 60.5 years (range: 24-84); 196 women) with severe fecal incontinence underwent a SNS test between January 2004 and December 2015. 176 cases (85%) had a stimulator implanted after a positive SNS test. 7 patients were lost of followup, and a follow-up of more than 5 years was complete in 60 cases (mean age 59 years, range: 29-76 years), whose results are reported here. The severity of FI was assessed by the FI Jorge and Wexner score (JWS), and the quality of life with the GIQLI scale. A subjective evaluation of the efficacy of the treatment was performed using a patient-reported numerical scale ranging from -5 (severe aggravation of symptoms) to +5 (excellent result). Associated symptoms were also evaluated according to the KESS questionnaire (constipation), the UDI6 questionnaire (urinary incontinence), and the HAD scale (anxiety and depression). Results were expressed as mean (SD), and comparisons performed by ANOVA or Chi2 test as appropriate. Results The median follow-up was 93 months (range: 60-171 months). There was a significant improvement of the JWS (8(1)/20 vs 14 (1)/20, p<0.0001) and the GIQLI (91 (3) vs 73 (3), p<0.0001) at the last point of follow-up compared to before SNS. Similarly, constipation score was improved (KESS: 13(1) vs 16(2), p=0.04), as well as UD6 (1.7(0.4) vs 2.1 (0.2), p=0.04), and anxiety score (9 (1) vs 11 (1), p=0.04). According to the numerical scale of subjective evaluation of the therapy, 36 patients (60%) reported a significant improvement (scale >+2), 5 (8%) a slight improvement (scale +1 or +2) and 19 (32%) reported no improvement (16 cases, scale=0) or a worsening of their condition (scale <0). Conclusion Results of SNS for FI appeared to maintain in the long term, with 60% of patients remaining satisfied with the technique more than 5 years after permanent implantation. Symptoms of FI are significantly decreased, as well as associated constipation and UI symptoms. Quality of life is improved, as well as anxiety status.
Sa1633 RISK FACTORS FOR FECAL INCONTINENCE IN PATIENTS WITH CROHN'S DISEASE Paul F. Vollebregt, Arjan Visscher, Adriaan A. van Bodegraven, R.J.F. Felt-Bersma Background and aim: Fecal incontinence (FI) has a great impact on daily (quality of) life and many patients are too embarrassed to report it spontaneously. Prevalence of FI in patients with Crohn's disease (CD) has barely been studied and little is known about factors predicting FI in these patients. To estimate its prevalence and evaluate potential causes in patients with complex CD, we studied a tertiary CD population and related outcome with quality of life. Methods: Consecutive patients with CD treated between 2003 and July 2013 at our center were identified in the prospectively maintained departments' IBD-database. A questionnaire was sent out in October 2013 to evaluate current complaints of FI, perianal disease and the Faecal Incontinence Quality of Life questionnaire. Demographic characteristics and medical history were collected by use of the IBD-database and additional chart review. Multivariate regression analysis was performed. Results: The questionnaire was responded by 325 out of 528 patients (62%). Median age of patients was 42 years (range 18-91), 215 (66%) were female and diagnosis of CD was established for a median period of 12 years (interquartile range 6-21). FI was reported by 65 patients (20%), median Cleveland Clinic Incontinence score was 12. FI was associated with liquid stools (p = 0.0001), previously performed IBD-related bowel resections (p = 0.001), stricturing behaviour of disease (p = 0.02) and perianal disease (p = 0.03). Quality of life (lifestyle, coping, depression, embarrassment) was poor in patients with FI, particularly in patients with more frequent episodes of incontinence. Conclusions: Prevalence of FI in a tertiary CD population is substantially higher than in the community-dwelling population. Considering the reduced quality of life in incontinent patients, active questioning to identify FI is recommended in those with liquid stools, perianal disease or previous (intestinal or perianal) surgery. Multimodality treatment is proposed due to the high impact on quality of life.
Sa1632 ANAL SPHINCTER FUNCTION EVALUATED BY 3D HIGH DEFINITION ANORECTAL MANOMETRY IN FECAL INCONTINENCE AND CHRONIC CONSTIPATION PATIENTS Francois Mion, Aurelien Garros, Henri Damon, Sabine Roman
Sa1634 RECTAL ENDOSCOPIC MUCOSAL RESECTION IS SUPERIOR TO RECTAL SUCTION BIOPSY FOR ANALYSIS OF ENTERIC GANGLIA IN CONSTIPATION AND GI DYSMOTILITY Kenneth Barshop, Field F. Willingham, William R. Brugge, Braden Kuo
Introduction 3D high definition anorectal manometry (3DARM) has been recently developed and commercialized, and reference values have been defined. However, the impact of this technique on the diagnostic workup of patients complaining of fecal incontinence (FI) or chronic constipation (CC) has not been assessed. The goal of this study was to analyze the various 3DARM variables describing anal sphincter function, and to test their ability to distinguish patients with FI from those with CC. Patients and methods. 114 consecutive patients (97 women, mean age: 55 years (range: 18-83)) seen in our lab because of FI (35 patients) or CC (79 patients) underwent 3DARM (rigid probe from Medtronic) with the
Background and aim: Adult and pediatric patients presenting with chronic constipation or motility disorders may be referred for rectal suction biopsy to rule out aganglionosis or Hirschsprung's disease (HD). This traditional diagnostic test, rectal suction biopsy (RSB), is a blind technique and may not be successful beyond infancy due to the increased thickness
S-313
AGA Abstracts
AGA Abstracts
Table 2. Clinical and obstetric characteristics and anorectal physiology in women with and without anal incontinence.