eP323 - Outcome Rate After Three Options of Fecal Incontinence Treatment. Is There Any Benefit to Offer Biofeedback Therapy?

Purpose/Background: The management of fecal incontinence(FI) remains challenging since that patients remain disappointed, waiting for an adequate treatment modality with relief of symptoms. This study aimed to investigate the impact of three modalities of FI treatment, such as biofeedback(BIO), eletroestimulation plus biofeedback(ELET+BIO) and sacral nerve stimulation(SNS) on the severity of symptoms and satisfaction rates of female patients into the success of each therapy.Methods/Interventions: A retrospective analysis was performed on a prospectively maintained database of a series of patients treated for FI at one institution over a 5-year period. All female included had no indication for surgery as well as were deemed intellectually capable for BIO treatment. Patients were assessed regarding severity of symptoms by CCF incontinence score(CCFIS), 3D anorectal ultrasonography, anal manometry and were distributed in three groups(as a first option):BIO; ELET+BIO and SNS. They were matched by age and according to the CCFIS≤10 and >10. Scores, percentage of response to treatment and satisfaction rates from 0(best) to 100(worst) by visual analogue scale(VAS) were compared between the groups at baseline and by the end of follow-up at 6 months for BIO and ELET+BIO and at least one year for SNS.Results/Outcomes: Of 165 patients, 58 treated by BIO(CCFIS≤10=34 and CCFIS>10=24); 51 ELET+BIO(31 and 20) and 56 SNS(11 and 45). The mean age, the distribution of patients with history of vaginal delivery/surgery or the presence of sphincter defects are similar. The resting pressure is lower in SNS(table). There is no complication in SNS group and all patients from BIO and ELET+BIO had undergone a full course of 7-8sessions. Overall pre-treatment score is significantly higher in SNS group than BIO and ELET+BI as well as the impact of VAS. The CCFIS score and VAS improved significantly from baseline to pos-treatment in all groups. However, the percentage of improvement is significantly higher in SNS compared with BIO and ELET+BIO(88%vs. 43%vs. 34% p < 0.00) as well as the VAS are lower, with better response pos-SNS. Moreover, all patients from SNS had improvement of FI symptoms>50%, and 30% had complete recovery of continence. However, reduced number of patient after BIO(33%) and ELET+BIO(18%) had improvement of symptoms>50%. In terms of distribution in sub-groups:In patients with CCFIS≤10, the pre-treatment score is significantly higher in the SNS compared with BIO and ELET+BIO as well as the impact of VAS; However, in those patients with CCFIS>10, the pre-treatment score is similar in all groups as well as the impact of VAS. Moreover, the percentage of improvement is higher after SNS (CCFIS≤10: SNS=94%vs. BIO=48%vs. ELT+BIO=40%/p < 0.00) and (CCFIS>10: SNS=87%vs. BIO=36%vs. ELT+BIO=24% /p < 0.00) as well as reduced VAS scores (CCFIS≤10: SNS=9vs. BIO=39vs. ELT+BIO=47/p=0.00) and (CCFIS>10: SNS=18vs. BIO=64vs. ELT+BIO=73/ p < 0.00).Conclusion/

Discussion: In this study, all 3 modalities of FI treatment used as first option, show significant reduced scores and improvement by VAS. However, the percentage of improvement is lower in the BIO and ELET+BIO modalities, even in patients with CCFIS≤10. Additionally, all patients treated by SNS have improved the symptoms >50% as well as with better satisfaction rates. Despite of similar characteristic between the groups concerning the age, sphincter defect, parity and previous surgery, the outcomes is not able to identify factors to determine the BIO and ELT+BIO as options for FI treatment with satisfactory response.Data compared by 3 options of modalities fecal incontinence treatment. One-way ANOVA, and the χ2 test were used with p < 0.05 and 95% of confidence intervals.
CCF incontinence score CCFIS / VAS- visual analogue scale ( from 0[best] to 100[worst).