Urge fecal incontinence: are intramural rectal injections of botulinum toxin a long-term treatment option?

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2024-12-19 DOI:10.1007/s10151-024-03050-x

Philippe Onana Ndong, Karine Baumstarck, Véronique Vitton

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Abstract

Background and aims: Unsuccessful first-line conservative treatments for managing fecal incontinence (FI) lead to considering predominantly invasive options, posing challenges in terms of cost and patient acceptance of benefit/risk ratio. Recent data from a prospective randomized study have highlighted intramural rectal botulinum toxin (BoNT/A) injection as a promising minimally invasive alternative for urge FI, demonstrating efficacy at 3 months but lacking long-term evidence. This study aimed to evaluate the sustained efficacy and injection frequency of intramural rectal BoNT/A injection in the treatment of urge FI.

Methods: This retrospective monocentric study enrolled all patients who underwent intramural rectal BoNT/A injection for urge FI after failed conservative therapy or sacral neuromodulation (SNM). Injections were administered during sigmoidoscopy, delivering 200 U of BoNT/A at 10 circumferentially distributed sites. Treatment effectiveness was assessed using the Cleveland clinic incontinence score (CCS) and a visual analog scale (VAS) to measure the severity of discomfort related to episodes of fecal urgency, with reinjection performed upon symptom recurrence.

Results: In total, 41 patients (34 females) were included, with a median follow-up of 24.9 (range 3.2-70.3) months. Overall, 11 patients had previously failed sacral nerve stimulation. Significant reductions were observed in the CCS (median 11 versus 7, p = 0.001) and VAS symptoms (median 4, range 0-5 versus median 2, range 0-5, p = 0.001). In total, 22 patients (53%) experienced a reduction in the CCS by over 50%. The median interval between intramural rectal BoNT/A injections was 9.8 months (range 5.3-47.9 months).

Conclusions: This study provides the first evidence of the sustained efficacy of intramural rectal BoNT/A injection for urge FI. Further investigations are warranted to refine patient selection and reinjection criteria, evaluate socioeconomic impacts, and compare rectal BoNT/A injection with other therapeutic modalities.

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急迫性大便失禁：直肠壁内注射肉毒杆菌毒素是一种长期治疗选择吗？

背景和目的：治疗大便失禁（FI）的一线保守治疗不成功导致考虑主要的侵入性选择，在成本和患者接受收益/风险比方面提出了挑战。最近一项前瞻性随机研究的数据强调，直肠肠壁内注射肉毒杆菌毒素（BoNT/ a）是一种有希望的微创治疗急性病的替代方法，在3个月时显示出疗效，但缺乏长期证据。本研究旨在评估直肠壁内注射BoNT/A治疗急迫性FI的持续疗效和注射频率。方法：这项回顾性单中心研究纳入了所有在保守治疗或骶神经调节（SNM）失败后接受直肠壁内BoNT/A注射治疗急迫FI的患者。在乙状结肠镜下进行注射，在10个圆周分布的部位注射200u BoNT/A。采用克利夫兰临床失禁评分（CCS）和视觉模拟量表（VAS）评估治疗效果，以测量与大便急症发作相关的不适程度，并在症状复发时进行再注射。结果：共纳入41例患者（女性34例），中位随访时间24.9个月（3.2 ~ 70.3个月）。总体而言，11名患者先前曾接受过骶神经刺激失败。观察到CCS（中位数为11比7，p = 0.001）和VAS症状（中位数为4，范围0-5比2，范围0-5，p = 0.001）显著降低。总共有22名患者（53%）的CCS降低了50%以上。直肠壁内BoNT/A注射的中位间隔为9.8个月（范围5.3-47.9个月）。结论：本研究首次提供了直肠壁内注射BoNT/A治疗急迫性FI持续有效的证据。需要进一步的研究来完善患者选择和再注射标准，评估社会经济影响，并将直肠BoNT/A注射与其他治疗方式进行比较。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.