We propose no update of the NICE guideline on constipation in children and young people.
The purpose of this exceptional review was to examine the effectiveness of transanal irrigation (TAI) as a management option for idiopathic constipation in children and young people. All other areas covered in the guideline scope were not considered by this exceptional review.
We decided to undertake an exceptional review of this area following the publication of NICE's medical technologies guidance on Peristeen transanal irrigation system for managing bowel dysfunction (MTG36) in February 2018. This guidance recommends the use of Peristeen, a TAI device, in children with bowel dysfunction. Because the population of NICE guideline CG99 could be covered by MTG36, we decided to review the area again and consider the impact on NICE's guideline on constipation in children and young people.
See appendix A: summary of evidence from surveillance for details of all evidence considered, and references.
The current guideline does not include recommendations about TAI for bowel management. This is because the evidence was previously considered to be too preliminary to inform recommendations in this area.
We considered the views of topic experts, including those who helped to develop the guideline. They were all in agreement that since the original guideline was produced in 2010, the use of TAI is becoming a more mainstream and viable option to manage idiopathic constipation when standard therapy has failed. They highlighted that a small proportion of children may be undergoing surgery (following a referral made in accordance with a current recommendation in NICE guideline CG99) when the non-surgical option of TAI may have been more appropriate. However, it is unclear to what extent this may be occurring in practice and no evidence was identified to confirm this.
Given that TAI is still a relatively invasive procedure compared to standard treatment with medication, they highlighted that it should only be considered if the child is truly treatment-resistant. They also added that TAI required careful case selection, education and support from a healthcare professional.
The current guideline does not include recommendations about TAI as a treatment option. The NICE medical technologies guidance on Peristeen transanal irrigation system for managing bowel dysfunction (MTG36) does recommend the use of Peristeen in children, however the evidence considered in this guidance was not in scope for NICE guideline CG99.
After taking into account the views of topic experts, we acknowledge that this is an area of research showing promising results for the treatment of constipation in this population. However, the findings from this exceptional review have demonstrated that the evidence on TAI has not substantially progressed since we last checked in 2017 and there is still uncertainty around the safety and efficacy of TAI in this population. For this reason, we will not update the guideline at this time.
This exceptional surveillance review did not search for new evidence relating to other clinical areas in the guideline.
After considering all evidence and other intelligence and the impact on current recommendations, we decided that no update is necessary at this time.
See how we made the decision for further information.
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