Authors' objectives: HTW assessed sacral nerve stimulation (SNS) to help decide whether it should be made available to treat patients in NHS Wales. This treatment is for people who have problems controlling their bowel movements and unexpectedly leak faeces. This is a disabling and socially embarrassing condition. Faecal incontinence can sometimes be controlled with traditional treatments such as the use of bulking agents, physiotherapy, and changes to their diet, but these don’t always work. SNS sends targeted, low strength electrical pulses to sacral nerve roots. There is evidence that it can reduce how often people suffer from incontinence.

Authors' results and conclusions: SNS is more expensive than traditional treatment, but still offers good value for money. HTW’s Guidance supports the use of sacral nerve stimulation when patients haven’t responded to traditional treatments and meet the criteria in the National Institute for Health and Care Excellence (NICE) Clinical Guideline 49.

Authors' recommendations: HTW advises that the available evidence supports the use of sacral nerve stimulation to treat faecal incontinence, only where the condition has not responded to conservative management. Sacral nerve stimulation should only be offered to people with faecal incontinence in line with the criteria outlined in the National Institute for Health and Care Excellence Clinical Guideline 49 (Faecal incontinence in adults: management).

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: Research into the long-term effectiveness of sacral nerve stimulation is recommended. This should capture outcomes including changes in frequency of faecal continence, quality of life, patient satisfaction, adverse events (particularly those that lead to device removal) and time to batterydepletion/replacement.

Project Status: Completed

Year Published: 2018

URL for published report: https://www.healthtechnology.wales/reports-guidance/sacral-nerve-stimulation/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: Floor 3, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk