TAI Consensus Paper, by Julie Storrie- Clinical Lead, Bowel at Clinisupplies

In this article, Julie walks us through her review and interpretation of the recently published paper

Bloem, M.N., Koppen, I.J.N. and Benninga, M.A. (2025) ‘Response to “Consensus on Safe Initiation and Monitoring of Transanal Irrigation to Optimise Adherence with Therapy” by Emmanuel et al. Neurogastroenterol Motil. 2025’, Neurogastroenterology and motility, 37(12), pp. e70113-n/a. Available at: https://doi.org/10.1111/nmo.70113.

Headlines:

The last best practice review of this kind was conducted more than 10 years ago and so this update is much needed especially as patient types treated with Transanal Irrigation has expanded so much over this time.

Furthermore, as a result this paper also recommended an update on the Contraindications and precautions as these had not been updated since the introduction of the treatment more than 15 years ago.

This is a large systematic review of more than 27 papers which covered a total of 1435 patients and therefore is a practical, evidence-based assessment of the use of TAI.

Here Julie talks us through her summary of the key takeaways from the review:

• Updated review focussed on issues around positioning of the catheter and inflation of the rectal balloon
• The average safety of TAI on a scale of 1-10 is 9.3, with no evidence of perforation using a cone and less than 250ml of water
• Safe Initiation of TAI includes proper training of patient, well-educated staff, and patient consent to risks and benefits
• Education and training is important, a well-structured first training session with regular, structured follow up
• Follow up is crucial to the success of TAI and can be done via telephone calls or face to face
• “Maintaining contact between HCP team and patient has shown to be effective in ensuring therapy adherence” (promotes AVNS)
• Much of follow up can be conducted remotely but initial training is best to be provided face to face (or virtually)

• The paper recommends starting at a low volume and then increasing until desired emptying is achieved, which is appropriate for patients with conditions and symptoms that may require a higher volume. For this group starting them on volumes such as 300-500mls and then increasing.
• High-volume TAI has in this review been defined as above 175 ml. This is a practical definition but based on the literature as well as knowledge about the rectal volume that is in between 150 and 250mls. The products available in the market have historically been classified as low and high. Since then, the mid volume irrigation product Aquaflush 500 has been introduced for those that need approximately 500mls of irrigation to achieve the desired results
• The average amount of volume used across the 27 Studies reviewed is reported at 700mls.

Finally on the update of contraindications Julie comments on the following:

Those related conditions that would be associated with an increased risk of perforation, such as colonic obstruction, known anal stenosis or colorectal stenosis, or active inflammatory bowel disease remain as contraindications

It is proposed that those conditions with less significant mechanical or vascular risk should be downgraded to ‘precaution’ status rather than being absolutely contraindicated.

This includes for example, patients on anticoagulant therapy (not including aspirin or clopidogrel), and patients who have had previous anal or colorectal surgery.

To hear more from Julie Storrie please follow the Clinisupplies page (insert link) and reach out to us at marketing@clinisupplies.co.uk should you have any specific questions for our Clinical Lead.