Long-term outcome and safety of transanal colonic irrigation for neurogenic bowel dysfunction

Study design: Long-term follow-up study. Objectives: Short-term results find transanal colonic irrigation (TAI) favourable in the treatment of neurogenic bowel dysfunction (NBD). Therefore, long-term results need to be described. Setting: Department of Surgery P, Aarhus University Hospital, Denmark. Methods: Between 1994 and 2007, 211 (115 female) patients with NBD (age: 7-81 years (median 49)) were introduced to TAI. One hundred and seventy-three patients had spinal cord injury and 38 had other neurological disorders. Data were obtained from hospital records and a mailed questionnaire. Treatment was considered successful in patients still using TAI, patients who had used TAI until they died and patients whose symptoms had resolved while using TAI. Results: Successful outcome was achieved in 98 (46%) patients after a mean follow-up of 19 months (range 1-114 months). A Kaplan-Meier plot showed a dropout of 20% in the first 3 months. After 3 years, the rate of success was 35% and remained almost unchanged afterwards. A regression analysis showed male gender (odds ratio (OR) 2.1), mixed symptoms (OR 2.9) and prolonged colorectal transit time (OR 2.4) to be significantly associated with successful outcome. One non-lethal bowel perforation occurred in approximately 50 000 irrigations (0.002%), whereas minor side effects were observed in 48%. Conclusion: After a mean follow-up of 19 months, 46% was successfully treated. The rate of success was 35% after 3 years and remained almost unchanged afterwards. TAI is safe and can be introduced to most patients suffering from NBD. Spinal Cord (2009) 47, 545-549; doi: 10.1038/sc.2008.159; published online 23 December 2008