Efficacy of Neuromodulation in Fecal Incontinence in Children; A Systematic Review and Meta-Analysis

Background: The results of existing studies regarding the use of neuromodulation in fecal incontinence (FI) are contradictory and therefore, a definitive conclusion cannot be made in this regard. Therefore, the aim of the present study is to evaluate the effectiveness of neuromodulation in controlling FI in children through a systematic review. Methods: A decision was made to perform the search in electronic databases of Medline, Embase, Web of Science, CINAHL and Scopus until end of October 2017. In the second step, the abstracts of the extracted studies were evaluated by 2 researchers independently and recorded in the data extraction form. Finally, All studies were summarized and categorized based on the evaluated outcomes and overall effect size was presented. Results: 5 studies were included in the present meta-analysis (including 115 children and adolescent. Pooled analysis also showed that the odds of improvement in the group under treatment with nerve stimulation was up to 20 times higher (OR=20.29; 95% CI: 8.67 to 47.45; p<0.0001). In addition, using nerve stimulation leads to a significant improvement in fecal incontinence score of patients (SMD = 2.32; 95% CI: 1.12 to 3.52; p<0.0001). Conclusion: It can be concluded that neuromodulation can seemingly be an effective measure in controlling FI in children. However, the lack of standard clinical trials in this field is highly felt and it is suggested to assess the effect of neuromodulation on FI by performing blinded randomized clinical trials in future studies.