The evidence on endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence raises no major safety concerns. There is evidence of efficacy in the short term, but in a limited number of patients. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to undertake endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients and their carers understand the uncertainty about the procedure's efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence (see section 3.1).
This procedure should only be carried out in units specialising in the assessment and treatment of faecal incontinence, as one of a range of treatment options.
Further research into endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence should clearly define the patient groups being treated. It should also report the clinical impact in terms of quality of life and long-term outcomes. NICE may review the procedure on publication of further evidence.