An open prospective study on the efficacy of Navina Smart, an electronic system for transanal irrigation, in neurogenic bowel dysfunction

Background Transanal irrigation (TAI) has emerged as a key option when more conservative bowel management does not help spinal cord injured (SCI) individuals with neurogenic bowel dysfunction (NBD). Aim To investigate the short-term efficacy and safety of an electronic TAI system (Navina Smart) in subjects with NBD. Design We present an open, prospective efficacy study on Navina Smart, in individuals with NBD secondary to SCI, studied at three months. Population Eighty-nine consecutive consenting established SCI individuals (61 male; mean age 48, range 18–77) naïve to TAI treatment were recruited from ten centres in seven countries. Subjects had confirmed NBD of at least moderate severity (NBD score ≥10). Methods Subjects were taught how to use the device at baseline assisted by the Navina Smart app, and treatment was tailored during phone calls until optimal TAI regime was achieved. The NBD score was measured at baseline and at three months follow up (mean 98 days). Safety analysis was performed on the complete population while per protocol (PP) analysis was performed on 52 subjects. Results PP analysis showed a significant decrease in mean NBD score (17.8 to 10, p<0.00001). In subjects with severe symptoms (defined as NBD score ≥14), mean NBD scores decreased (19.4 to 10.9, p<0.0001). The number of subjects with severe symptoms decreased from 41 (79%) subjects at baseline to 16 (31%) at three months follow-up. Device failure accounted for the commonest cause for loss of data. Side effects possibly related to the device developed in 11 subjects (12%). Discontinuation due to failure of therapy to relieve symptoms was reported by 5 subjects (6%). Conclusion Navina Smart is effective for individuals with NBD, even those with severe symptoms; long-term data will follow. Whilst there were some device problems (addressed by the later stages of subject recruitment) the treatment was generally safe. Clinical trial (ClinicalTrials.gov number NCT02979808)

Download Full-text

Long-Term Cost-Effectiveness of Transanal Irrigation In Patients With Neurogenic Bowel Dysfunction Who Have Failed Standard Bowel Care

Value in Health ◽

10.1016/j.jval.2015.09.691 ◽

2015 ◽

Vol 18 (7) ◽

pp. A360 ◽

Cited By ~ 3

Author(s):

A Emmanuel ◽

P Christensen ◽

G Kumar ◽

V Passananti ◽

S Mealing ◽

...

Keyword(s):

Cost Effectiveness ◽

Bowel Dysfunction ◽

Transanal Irrigation ◽

Neurogenic Bowel

Download Full-text

Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction

PLoS ONE ◽

10.1371/journal.pone.0159394 ◽

2016 ◽

Vol 11 (8) ◽

pp. e0159394 ◽

Cited By ~ 21

Author(s):

Anton Emmanuel ◽

Gayathri Kumar ◽

Peter Christensen ◽

Stuart Mealing ◽

Zenia M. Størling ◽

...

Keyword(s):

Cost Effectiveness ◽

Bowel Dysfunction ◽

Transanal Irrigation ◽

Neurogenic Bowel

Download Full-text

LONG-TERM COST SAVINGS OF TRANSANAL IRRIGATION IN PATIENTS WITH NEUROGENIC BOWEL DYSFUNCTION: A MEDICARE PAYER PERSPECTIVE

Value in Health ◽

10.1016/j.jval.2016.03.715 ◽

2016 ◽

Vol 19 (3) ◽

pp. A303

Author(s):

A. Emmanuel ◽

F.B. Andersen ◽

S. Kirshblum

Keyword(s):

Cost Savings ◽

Bowel Dysfunction ◽

Transanal Irrigation ◽

Payer Perspective ◽

Neurogenic Bowel

Download Full-text

Long-term follow-up study of intraurethral stents in spinal cord injured patients with detrusor-sphincter dyssynergia

Spinal Cord ◽

10.1038/sj.sc.3102011 ◽

2007 ◽

Vol 45 (9) ◽

pp. 621-626 ◽

Cited By ~ 16

Author(s):

S Seoane-Rodríguez ◽

J Sánchez R-Losada ◽

A Montoto-Marqués ◽

S Salvador-de la Barrera ◽

M E Ferreiro-Velasco ◽

...

Keyword(s):

Spinal Cord ◽

Follow Up Study ◽

Detrusor Sphincter Dyssynergia ◽

Long Term Follow Up ◽

Injured Patients ◽

Spinal Cord Injured

Download Full-text

LONG-TERM FOLLOW UP OF SPHINCTEROTOMY IN SPINAL CORD INJURED MEN

The Japanese Journal of Urology ◽

10.5980/jpnjurol1989.99.7 ◽

2008 ◽

Vol 99 (1) ◽

pp. 7-13

Author(s):

Ryosuke Takahashi ◽

Yasusuke Kimoto

Keyword(s):

Spinal Cord ◽

Long Term Follow Up ◽

Spinal Cord Injured

Download Full-text

Long-Term Results after Anastomotic Leakage following Rectal Cancer Surgery: A Comparison of Treatment with Endo-Sponge and Transanal Irrigation

Digestive Surgery ◽

10.1159/000508935 ◽

2020 ◽

Vol 37 (6) ◽

pp. 456-462

Author(s):

Alice Weréen ◽

Martin Dahlberg ◽

Göran Heinius ◽

Emil Pieniowski ◽

Deborah Saraste ◽

...

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Small Sample ◽

Long Term Results ◽

Rectal Cancer Surgery ◽

Stoma Closure ◽

Closure System ◽

Transanal Irrigation

Objective: We aimed to evaluate long-term results in patients from regular health care treated with endoscopic transanal closure system, that is, endoscopic vacuum-assisted closure system (EVAC) compared to transanal irrigation. Methods: In this retrospective, medical chart-based, observational study, we included patients with anastomotic leakage after low anterior resection for rectal cancer from 3 Stockholm hospitals 2006–2016 and compared time to first stoma closure in a Kaplan-Meier model and the proportion of patients who were stoma-free at end of follow-up. Results: Anastomotic leakage was found in 81 patients who were followed up in median 5.9 years (min–max: 0.53–13). EVAC was used on 14 (17%) patients and transanal irrigation on 34 (42%) patients. The remaining 33 (41%) patients either got a permanent colostomy or were treated only with antibiotics and percutaneous drainage. Treatment with EVAC or transanal irrigation led to similar rates of stoma closure, both when comparing all patients, and when comparing patients with similar defects. At the end of follow-up, 43% of patients treated with EVAC and 50% of patients treated with repeated irrigation were stoma-free (p = 0.75). Conclusions: We found no evidence of better outcomes in patients treated with EVAC. The study was, however, limited by small sample size.

Download Full-text

Development of a decision guide for transanal irrigation in bowel disorders

Gastrointestinal Nursing ◽

10.12968/gasn.2019.17.7.24 ◽

2019 ◽

Vol 17 (7) ◽

pp. 24-30 ◽

Cited By ~ 3

Author(s):

Anton Emmanuel ◽

Brigitte Collins ◽

Michelle Henderson ◽

Lisa Lewis ◽

Kelly Stackhouse

Keyword(s):

Patient Education ◽

Best Practice ◽

Healthcare Providers ◽

Working Party ◽

Bowel Function ◽

Bowel Dysfunction ◽

Optimal Decisions ◽

Transanal Irrigation ◽

Bowel Disorders

Transanal irrigation (TAI), which has emerged as a therapy for patients with bowel dysfunction, can aid emptying of the bowel and help to re-establish control of bowel function by choosing the time and place of evacuation. Because of the ever-growing numbers of TAI systems available, choosing the optimal equipment can be overwhelming. Therefore, a consensus review of best practice from a working party of experts was thought to represent the most appropriate means of arriving at clinically meaningful advice. This led to the production of an article as well as a decision-guide booklet to aid choice of equipment, initiation, patient education, regimen setting and follow-up. These are designed to help healthcare providers initiating TAI to make optimal decisions for each individual patient.

Download Full-text

Efficiency and acceptability of an automated electronic system (DayCOR) compared with a telephone call system, for follow-up of day surgery patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x19839359 ◽

2019 ◽

Vol 47 (3) ◽

pp. 242-250 ◽

Cited By ~ 3

Author(s):

Nicole LT Tan ◽

John R Sestan

Keyword(s):

Demographic Data ◽

Electronic System ◽

Day Surgery ◽

Telephone Call ◽

Healthcare Organisation ◽

Post Discharge ◽

Phone Calls ◽

Patient Reported ◽

Call System

Post-discharge phone calls are a widely used yet suboptimal method of ascertaining recovery of day surgery patients. We compared the efficiency of an automated electronic system of follow-up, the Day Care Anaesthesia Outcomes Recording Registry (DayCOR), and a telephone call system that was standard practice in our non-profit private healthcare organisation in Victoria, Australia. We also surveyed a group of clinicians to assess their acceptance of DayCOR compared with the telephone call system. DayCOR is a web-based system which collects, alerts, manages and analyses patient-reported outcomes. Patients may opt in to respond to a 15-question survey via a link sent by text message or email. DayCOR’s patient response rate was 77.5%, compared with 66.0% for the telephone call system. Both systems collected data on clinical, process, and experience outcomes. Completeness of data collection was 100% using DayCOR compared with 51%–61.4% of data items using the telephone call system. We estimated that replacing our telephone call system with DayCOR to follow up 60,000 day surgery patients a year would represent an annual cost reduction of AUD$101,345 (53%) using manual demographic data entry, and AUD$142,745 (74%) if DayCOR was integrated with the institution’s existing administrative software. Seventy-eight percent of day surgery nurses and 94% of anaesthetists preferred DayCOR to the telephone call system. All anaesthetists surveyed stated that DayCOR provided more valuable feedback, and almost one-fifth had changed their clinical practice as a result. DayCOR’s efficiency and acceptability will allow more effective collection of post-discharge patient outcomes than is currently possible in our institution, and will support interventional studies aimed at improving quality of recovery of day surgery patients.

Download Full-text