Effect of Sacral Nerve Stimulation on Enteric Nervous System

Study Overview
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Brief Summary
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Sacral nerve stimulation (SNS) is a new therapeutic option to treat fecal incontinence, although its mecanims of action remains poorly understood. The investigators hypothtized that SNS could act on enteric nervous system (ENS). To verify this hypothesis, the investigators will collect biopsy samples from patients implanted for SNS, and assess whether SNS induces changes in ENS.

Detailed Description
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Sacral nerve stimulation (SNS) is a new therapeutic option to treat fecal incontinence. Its efficacy yields 80% approximately, but its mecanims of action remains poorly understood. In particular, SNS does not restore anal squeezing contraction nor it increase anal tone. Recently, using a porcine model, it was shown that SNS changed colonic permeability, suggesting that SNS may activate the enteric nervous system (ENS). The investigators hypothtized therefore that SNS could act on enteric nervous system (ENS). To verify this hypothesis, the investigators will collect biopsy samples from patients before and after implantation for SNS. The investigators will assess whether SNS induces changes in ENS, and if this is correlated to SNS efficacy.

Official Title
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Effect of Sacral Nerve Stimulation on Enteric Nervous System

Conditions
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Fecal Incontinence

Intervention / Treatment
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* Procedure: Sacral nerve stimulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Fecal incotinence refractory to medial treatment Eligible to a treatment with sacral nerve stimulation Exclusion Criteria: age < 18 yo age < 75 yo anal defect > 120° bilateral interruption of the bulbo-cavernous reflex patient not able to speack and understand the French Language patient not affilated to the French healthcare system pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Fecal incontinence<br>Patient with fecal incontinence and referred for a treatment with sacral nerve stimulation | Procedure: Sacral nerve stimulation<br>* implantation of a stimulation electrode in one of the S2-S3-S4 sacral hole then connected to a subcutaneous stimulator for permanent stimulation of the sacral nerve<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of neurons producing vasoactive intestinal peptide (VIP) | Number of neurons producing vasoactive intestinal peptide (VIP) by immunochemistry | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of cholinergic neurons | Number of cholinergic neurons by immunochemistry | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Fecal incontinence, sacral nerve stimulation