Sacral Nerve Stimulation Therapy for the Treatment of Chronic Fecal Incontinence

Medtronic InterStim® Sacral Nerve Stimulation Therapy for Bowel Control: Fecal Incontinence Study

Fecal incontinence (FI) is a difficulty in storing gas, liquid stool or solid stool (bowel movement) in order to expel it at a proper time and place. Patients who suffer from FI may experience passive FI (difficulty in sensing stool in the rectum) or urgency (able to sense a bowel movement but cannot hold the stool until an acceptable time and place). FI is not a life-threatening disease, but it is often profoundly distressing and socially incapacitating.

If a patient is suffering with symptoms of chronic FI despite trying oral medications, biofeedback and/or other more conservative treatments, a patient may be eligible to participate in a clinical research study to evaluate the safety and effectiveness of sacral nerve stimulation for the treatment of chronic fecal incontinence. One hundred-twenty (120) patients will be implanted with medical devices and followed closely for twelve months, and then once a year after that until the study closes. There are up to 20 centers in the United States.

Study Overview

• Status: Completed
• Conditions: Fecal Incontinence
• Intervention / Treatment: Device: InterStim Sacral Nerve Stimulation Therapy

• Study Type: Interventional
• Enrollment (Actual): 285
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Quebec
    • Fleurimont, Quebec, Canada
      • Contact Medtronic for specific site information
• United States
  • California
    • Los Angeles, California, United States
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    • San Francisco, California, United States
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  • District of Columbia
    • Washington, District of Columbia, United States
      • Contact Medtronic for specific site information
  • Florida
    • Weston, Florida, United States
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  • Illinois
    • Chicago, Illinois, United States
      • Contact Medtronic for specific site information
  • Kansas
    • Kansas City, Kansas, United States
      • Contact Medtronic for specific site information
  • Louisiana
    • New Orleans, Louisiana, United States
      • Contact Medtronic for specific site information
  • Massachusetts
    • Burlington, Massachusetts, United States
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  • Minnesota
    • Minneapolis, Minnesota, United States
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  • Ohio
    • Cleveland, Ohio, United States
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  • Oklahoma
    • Oklahoma City, Oklahoma, United States
      • Contact Medtronic for specific site information
  • Texas
    • Fort Worth, Texas, United States
      • Contact Medtronic for specific site information

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Signed and dated informed consent.
• 18 years of age or older.
• Patient is diagnosed with chronic fecal incontinence of a duration greater than 6 months (>12 months post-vaginal childbirth) and defined as > 2 incontinent episodes on average per week of more than staining recorded during the baseline diary period.
• Failed or are not candidates for more conservative treatments.
• Willing and competent to completely and accurately fill out bowel diaries and questionnaires throughout the study.

Exclusion Criteria:

• Congenital anorectal malformations.
• Active participation in another bowel disorder investigational study.
• Present rectal prolapse.
• Previous rectal surgery (such as rectopexy or resection) or sphincteroplasty done < 12 months prior to study enrollment (24 months for cancer).
• Neurological diseases such as clinically significant peripheral neuropathy or complete spinal cord injury (i.e. paraplegia).
• Grade III hemorrhoids.
• Known or suspected organic disorders of the bowel (i.e. Inflammatory bowel disease such as Crohn's or ulcerative colitis).
• Chronic watery diarrhea, unmanageable by drugs or diet, as primary cause of fecal incontinence. (Incontinent episodes with a Bristol stool consistency of > 6 for > 4 days during the baseline diary period will be exclusionary, unless the investigator determines that the diary is not indicative of chronic watery diarrhea.)
• Pregnancy or planned pregnancy.
• Patients for whom patient materials are not available in a language understood by the patient.
• Life expectancy of less than one year.
• Patient characteristics indicating a poor understanding of the study or poor compliance with the study protocol (i.e., patients unable to adequately operate equipment, patients unwilling or unable to return for scheduled follow-up visits).
• Patients with a history of pelvic irradiation who present with visible or functional effects of irradiation.
• Patients with active anal abscesses or fistulas.
• Patients with anatomical limitations that would prevent the successful placement of an electrode.
• Patients with knowledge of planned MRIs, diathermy, microwave, or RF energy.
• Patients with other implantable neurostimulators, pacemakers or defibrillators.
• Defect of external anal sphincter of >60 degrees or amenable to surgical repair.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NON_RANDOMIZED
• Interventional Model: SINGLE_GROUP
• Masking: NONE

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Subjects With at Least 50% Reduction in Number of Incontinent Episodes Per Week	The primary efficacy objective was to demonstrate that at least 50% of subjects will achieve at least 50% reduction in the number of fecal incontinent episodes per week at 12 months post-implant compared to baseline. Subjects who achieve at least 50% reduction in the number of fecal incontinent episodes per week at 12 months post-implant compared to baseline are considered "successes." The observed therapeutic success rate is calculated as the proportion of implanted subjects who achieve at least 50% reduction in the number of incontinent episodes per week from baseline to twelve months.	Baseline and 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Subjects With at Least 50% Reduction in Number of Incontinent Days Per Week	This secondary objective was to demonstrate that at least 50% of subjects achieved at least 50% reduction in the number of incontinent days per week at 12 months post-implant compared to baseline. Subjects who achieve at least 50% reduction in the number of fecal incontinent days per week at 12 months post-implant compared to baseline are considered "successes." The observed therapeutic success rate is calculated as the proportion of implanted subjects who achieve at least 50% reduction in the number of incontinent days per week from baseline to twelve months.	Baseline and 12 months
Change in Quality of Life From Baseline to 12 Months: Scale 1 - Lifestyle	This secondary efficacy objective was to demonstrate improvement in Fecal Incontinence Quality of Life (FIQOL) scores at 12 months post-implant compared to baseline. Scales range from 1 to 5, with a 1 indicating a lower functional status of quality of life. The four component scales of the FIQOL instrument were evaluated separately.	Baseline and 12 months
Change in Quality of Life From Baseline to 12 Months: Scale 2 - Coping/Behavior	This secondary efficacy objective was to demonstrate improvement in Fecal Incontinence Quality of Life (FIQOL) scores at 12 months post-implant compared to baseline. Scales range from 1 to 5, with a 1 indicating a lower functional status of quality of life. The four component scales of the FIQOL instrument were evaluated separately.	Baseline and 12 Months
Change in Quality of Life From Baseline to 12 Months: Scale 3 - Depression/Self-Perception	This secondary efficacy objective was to demonstrate improvement in Fecal Incontinence Quality of Life (FIQOL) scores at 12 months post-implant compared to baseline. Scales range from 1 to 5, with a 1 indicating a lower functional status of quality of life. The four component scales of the FIQOL instrument were evaluated separately.	Baseline and 12 Months
Change in Quality of Life From Baseline to 12 Months: Scale 4 - Embarrassment	This secondary efficacy objective was to demonstrate improvement in Fecal Incontinence Quality of Life (FIQOL) scores at 12 months post-implant compared to baseline. Scales range from 1 to 5, with a 1 indicating a lower functional status of quality of life. The four component scales of the FIQOL instrument were evaluated separately.	Baseline and 12 Months
Proportion of Subjects With at Least 50% Reduction in Number of Urgent Incontinent Episodes Per Week	This secondary objective was to demonstrate that at least 50% of subjects achieved at least 50% reduction in the number of urgent incontinent episodes per week at 12 months post-implant compared to baseline. Subjects who achieve at least 50% reduction in the number of urgent fecal incontinent episodes per week at 12 months post-implant compared to baseline are considered "successes." The observed therapeutic success rate is calculated as the proportion of implanted subjects who achieve at least 50% reduction in the number of urgent incontinent episodes per week from baseline to 12 months.	Baseline and 12 months

Collaborators and Investigators

• Sponsor: MedtronicNeuro
• Investigators: Study Director: Sudha Iyer, PhD, Medtronic

Publications and helpful links

General Publications

• Wexner SD, Coller JA, Devroede G, Hull T, McCallum R, Chan M, Ayscue JM, Shobeiri AS, Margolin D, England M, Kaufman H, Snape WJ, Mutlu E, Chua H, Pettit P, Nagle D, Madoff RD, Lerew DR, Mellgren A. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. 2010 Mar;251(3):441-9. doi: 10.1097/SLA.0b013e3181cf8ed0.
• Wexner SD, Hull T, Edden Y, Coller JA, Devroede G, McCallum R, Chan M, Ayscue JM, Shobeiri AS, Margolin D, England M, Kaufman H, Snape WJ, Mutlu E, Chua H, Pettit P, Nagle D, Madoff RD, Lerew DR, Mellgren A. Infection rates in a large investigational trial of sacral nerve stimulation for fecal incontinence. J Gastrointest Surg. 2010 Jul;14(7):1081-9. doi: 10.1007/s11605-010-1177-z. Epub 2010 Mar 31.

Study record dates

Study Major Dates

• Study Start: January 1, 2002
• Primary Completion (ACTUAL): August 1, 2007
• Study Completion (ACTUAL): September 1, 2011

Study Registration Dates

• First Submitted: September 12, 2005
• First Submitted That Met QC Criteria: September 12, 2005
• First Posted (ESTIMATE): September 20, 2005

Study Record Updates

• Last Update Posted (ESTIMATE): January 24, 2013
• Last Update Submitted That Met QC Criteria: January 17, 2013
• Last Verified: January 1, 2013

More Information

Terms related to this study

• Keywords: InterStim; Fecal Incontinence
• Additional Relevant MeSH Terms: Digestive System Diseases; Gastrointestinal Diseases; Intestinal Diseases; Rectal Diseases; Fecal Incontinence
• Other Study ID Numbers: G010206