Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2017; 23(11): 2029-2036
Published online Mar 21, 2017. doi: 10.3748/wjg.v23.i11.2029
Predictive factors for compliance with transanal irrigation for the treatment of defecation disorders
Clémence Bildstein, Chloé Melchior, Guillaume Gourcerol, Estelle Boueyre, Valérie Bridoux, Eric Vérin, Anne-Marie Leroi
Clémence Bildstein, Chloé Melchior, Guillaume Gourcerol, Estelle Boueyre, Anne-Marie Leroi, INSERM U1073, Service de Physiologie Digestive, CHU Rouen, F-76000 Rouen, France
Valérie Bridoux, INSERM U1073, Service de Chirurgie Digestive, CHU Rouen, F-76000 Rouen, France
Eric Vérin, EA 3830, Pôle 3R, CHU Rouen, Groupe de Recherche sur le Handicap Ventilatoire, F-76000 Rouen, France
Anne-Marie Leroi, INSERM CIC 0204, F-76000 Rouen, France
Author contributions: Leroi AM designed the study, conducted the research, performed the statistical analyses of the results, wrote the paper, and approved the final version to be submitted for publication; Melchior C, Gourcerol G, Bridoux V, and Vérin E recruited the patients, conducted the research, participated in drafting the final version of the paper, and approved the final version to be submitted for publication; Bildstein C and Boueyre E collected and analyzed the data and approved the final version to be submitted for publication.
Institutional review board statement: This study was reviewed and approved by local Ethics Committee (No. E2016-64).
Informed consent statement: The study was performed in accordance with the Declaration of Helsinki, Good Clinical Practice and applicable regulatory requirements. No informed consent was required under French legislation since it was a retrospective study with no interventions other than routine patient care.
Conflict-of-interest statement: None of the authors has a conflict of interest regarding this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anne-Marie Leroi, MD, PhD, INSERM U1073, Service de Physiologie Digestive, CHU Rouen, 1 rue de Germont, F-76000 Rouen, France. annemarie.leroi@wanadoo.fr
Telephone: +33-2-32888785 Fax: +33-2-32888425
Received: November 12, 2016
Peer-review started: November 15, 2016
First decision: December 19, 2016
Revised: December 30, 2016
Accepted: January 11, 2017
Article in press: January 11, 2017
Published online: March 21, 2017
Abstract
AIM

To investigate compliance with transanal irrigation (TAI) one year after a training session and to identify predictive factors for compliance.

METHODS

The compliance of one hundred eight patients [87 women and 21 men; median age 55 years (range 18-83)] suffering from constipation or fecal incontinence (FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and training progress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.

RESULTS

Forty-six of the 108 (43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy (41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems (catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training (OR = 4.9, 1.3-18.9, P = 0.02).

CONCLUSION

The progress of the training session was the only factor that predicted patient compliance with TAI.

Keywords: Neurogenic bowel dysfunction, Fecal incontinence, Constipation, Obstructed defecation, Transanal irrigation

Core tip: Less than 50% of the trained patients continued to use transanal irrigation (TAI) for the treatment of their defecation disorders one year after their training sessions. We showed for the first time that the only predictive factor for TAI discontinuation was the progress of the training. This suggested that the first training session should be better structured in order to promote more realistic expectations of treatment efficacy, side-effects, and constraints in order to reduce the discontinuation rate.