Consensus on discontinuation, refusal, and adherence to transanal irrigation in coloproctology: a national Delphi study in Spain
Transanal irrigation (TAI) is used in a range of functional digestive disorders; however, its clinical implementation remains notably heterogeneous. The absence of clear operational definitions for discontinuation, refusal, and adherence hampers the interpretation of outcomes and comparison across centres. The aim of this study was to reach a national consensus on these concepts through a structured Delphi process. A national Delphi study was conducted following the RAND/UCLA methodology over two consecutive rounds. The questionnaire included 46 items distributed across four thematic sections and two exploratory parts. RAND/UCLA criteria were applied to determine appropriateness and degree of consensus, and items without consensus were reconsidered in the second round. A total of 111 professionals with experience in TAI were invited to participate; 100 completed the first round and 91 the second. Of the 46 items, 24 (52.17%) reached consensus: 17 in the first round and 7 in the second. The strongest agreements were found around the differentiation between discontinuation and refusal, the behavioural definition of adherence, and the importance of initial information, systematic identification of discontinuation causes, and the need for structured follow-up programmes. Areas without consensus included logistical aspects, temporal criteria, and certain operational interventions, as well as professional profile–based discrepancies in specific items. This study provides consensus-based operational definitions and clinical criteria applicable to TAI practice in Spain. The agreements reached offer a solid foundation for standardising key concepts, improving outcome evaluation, and guiding the development of more consistent clinical guidelines and care pathways.
Authors
- Vicente Simó (ORCID: https://orcid.org/0000-0003-3392-1933)
- José María Jiménez (ORCID: https://orcid.org/0000-0003-4264-6582)
- Antonio Pérez (ORCID: https://orcid.org/0000-0001-5528-1143)
- Paula Martínez (ORCID: https://orcid.org/0000-0003-2620-7643)
- María José Alcaide (ORCID: https://orcid.org/0000-0002-8858-8974)
- Javier Hernáez
- Irene Avila (ORCID: https://orcid.org/0009-0006-8020-547X)
- Mireia Lázaro
- Vicent Primo Romaguera (ORCID: https://orcid.org/0000-0001-6659-5391)
- Sara Martínez
- Franco Marinello (ORCID: https://orcid.org/0000-0003-0185-4545)
- Ana Sánchez (ORCID: https://orcid.org/0000-0003-3283-8812)
- Belén Martínez (ORCID: https://orcid.org/0000-0001-6587-9835)
- Javier Serrano (ORCID: https://orcid.org/0000-0002-0322-7863)
- Rosa Costa (ORCID: https://orcid.org/0000-0002-2607-7159)
- Ana López
- Loris Trenti (ORCID: https://orcid.org/0000-0003-3153-5115)
- Eduardo Martínez (ORCID: https://orcid.org/0000-0003-0739-0999)
- Alberto Parajó
- Sandra Pérez
- Marta Pérez (ORCID: https://orcid.org/0000-0003-0000-1938)
- María José García (ORCID: https://orcid.org/0000-0002-6517-7005)
- Luis García (ORCID: https://orcid.org/0000-0003-0243-6636)
- Cristina García
- A. Pereda Pérez
- Isabel Sánchez
- Marta Climent
- Ana Fernández
- Ana Ruiz
- Milagros Carrasco
- José Antonio Martínez
- Patricia Sánchez
- Francisco Javier Alarcón (ORCID: https://orcid.org/0000-0002-7900-5626)
- Pere Planellas
- Cristina Sánchez
- Alejandro Garcia
- Luis Miguel Martín
- Marta Sánchez
- The Coloproctology Expert Group (GEC)
- Mª Paz Vicario
- Belén Rodríguez
- Sara García
- María Sánchez
- Cristina Martínez
- Iván Blasco
- Patricia Martín
- Verónica Cañete
- Marta García
- Lucía Pérez
- Irene García
- Javier García
- Diego García
- Sara Pérez
- Jorge Expósito
- Laura García
- Maider Zubiaga
- Natalia Zaragoza
- Jesús García
- Laura Martínez
- Nerea Salas
- Andrés Vargas
- Francisco José García
- Santiago Gómez
- Ane Etxart
- Blanca Moreno
- María del Mar García
- Laura Sánchez
- Marina González
- Luis Alberto Campos
- María López
- Elena Bermejo (ORCID: https://orcid.org/0000-0002-4763-388X)
- Sara Romero
- Ana Isabel Sanz
- Noelia García
- Rosa María Pérez
- María Pilar Martínez
- Laura Ruiz
- Paula López
- Francesca Rico
- Luis Miguel Ruano
- Alberto González
- Goizalde Cabello
- Cristina Pérez
- Elvira Sánchez
- Sara Ruiz
- Ana Margarita Valencia
- María Pérez
- Gregorio Ruiz
- Paula Pérez
- Laura Pérez
- Sara Tavares-Nogueira
- Mercedes Granados
- Roberto Sacristán
- Ana Belen Flores
- Cristobal Cañete
- Cristina López
- María Ruiz
- Elena Yagüe
- Susana Pérez
Institutions
- Universitat Autònoma de Barcelona (ES)
- Universitat de Girona (ES)
- Hospital Universitari i Politècnic La Fe (ES)
- Biogipuzkoa Health Research Institute (ES)
- Institut d'Investigació Biomèdica de Girona (ES)
- Hospital Clínic de Barcelona (ES)
- Hospital General Universitario de Elche (ES)
- Vall d'Hebron Hospital Universitari (ES)
- Hospital Reina Sofía de Murcia (ES)
- Hospital Universitario de La Princesa (ES)
- Complejo Hospitalario de Pontevedra (ES)
Publication Details
- Journal
- International Journal of Colorectal Disease
- Published
- 2026-08-03
- DOI
- https://doi.org/10.1007/s00384-026-05211-w
- Primary Topic
- Stoma care and complications
- Type
- article
- Field-Weighted Citation Impact
- 0.00