14781-koppen

301 Outcomes of sacral nerve stimulation 15 INTRODUCTION Constipation is a common problem in children, with an estimated worldwide prevalence of 12%. 1 While the majority of children respond to medical and behavioral treatment, a sizable portion of these children continue to have symptoms despite conventional treatment. 2 Unfortunately, treatment options for children with constipation refractory to conventional treatment are limited. The most recent guidelines from the European and North American pediatric gastroenterology societies on the evaluation and treatment of functional constipation in children recommend consideration of anal sphincter botulinum toxin injection, transanal irrigation, antegrade continence enemas (ACE), sacral nerve stimulation (SNS), and partial or total colonic resection for treatment of intractable constipation. 3–5 Sacral nerve stimulation involves low-amplitude electrical stimulation of the sacral nerve via an electrode placed through the sacral foramen. Over the past two decades, experience with the use of SNS to treat adults with constipation and fecal incontinence has grown, and SNS is now considered the first-line surgical treatment for adults with fecal incontinence refractory to conventional treatment. 6 However, recent studies have not shown SNS to be an effective treatment for adults with constipation. 7,8 Experience with the use of SNS in children with constipation has been positive thus far but remains limited, and the long-term outcomes of SNS treatment in children with constipation are not yet clearly understood. 9–11 Although SNS appears to be a promising treatment option for children with refractory constipation, an understanding of its long-term efficacy and safety in children is needed before this treatment modality becomes more widely accepted. Therefore, the objective of our study was to describe the long-term outcomes of children with constipation treated with SNS by evaluating changes in symptom severity and quality of life, perceived health- related patient benefit, and parent satisfaction. MATERIALS AND METHODS We performed a prospective observational cohort study. We included patients up to 21 years of age with constipation who underwent SNS initiation at Nationwide Children's Hospital in Columbus, OH, USA between May 2012 and November 2013 and therefore had been treated with SNS for at least 2 years at the time of data collection in November 2015. We recorded information on patient symptoms, laxative and ACE usage, patient- reported outcomes, relevant diagnostic test results, and complications of SNS at baseline and at each follow-up visit after SNS initiation. Patient-reported measures of symptom severity and quality of life included the PedsQL Gastrointestinal Symptom Scale (GSS), Fecal Incontinence Quality of Life Scale (FIQL), and Fecal Incontinence Severity Index (FISI). 12–14