Greater sensitivity to rapid pressure change is one of the advantages associated with SS HR-ARM. This is reflected in the differences observed during dynamic maneuvers performed during this study. Catheter type should be taken into consideration when selecting normal ranges for comparison to disease states.

Background Using high‐resolution anorectal manometry, we aimed to evaluate the: (a) optimal threshold to measure functional anal canal length (FACL) with intra‐ and inter‐observer variability; (b) relationship between abnormal FACL and other phenotypic findings; and (c) utility of FACL measurement to discriminate between healthy volunteers (HV) and patients with fecal incontinence (FI) or chronic constipation (CC). Methods Consecutive patients referred for investigation of FI or CC in isolation were included. FACL was calculated at 5, 10, 20, 30, and 50 mm Hg above rectal pressure. 5th‐95th percentile in HV defined limits of normality. Key Results FACL was analyzed in 192 patients with FI (154 females), 204 patients with CC (175 females), and 134 HV (101 females). The optimal threshold for measurement of FACL was 20 mm Hg. Using this threshold, observer reproducibility was very high (ICC 0.99, P < 0.0001). FACL was shorter in females with FI and longer in females with CC compared to HV (2.3 vs 2.9 cm; and 3.4 cm vs 2.9 cm; both P < 0.0001). Twenty percent of females and 13% males with FI had a short FACL, associated with older age, anal hypotonia or hypocontractility, and a atrophic internal anal sphincter. However, abnormal FACL in isolation was only found in 1/190 FI (0.5%) and 2/201 CC (1%) patients; all other patients had other abnormal manometric findings. Conclusions and Inferences Considering overlap with other routinely evaluated manometric parameters, FACL measurement does not provide additional information in the diagnostic assessment of FI or CC.

ObjectiveThe ACROBAT pilot trial of early cryoprecipitate for severe postpartum haemorrhage used deferred consent procedures. Pretrial discussions with a patient and public involvement group found mixed views towards deferred consent. This study aimed to build an understanding of how the deferred consent procedures worked in practice, to inform plans for a full-scale trial.SettingQualitative interview study within a cluster-randomised pilot trial, involving four London maternity services.ParticipantsIndividual interviews were conducted postnatally with 10 women who had received blood transfusion for severe postpartum haemorrhage and had consented to the trial. We also interviewed four ‘recruiters’—two research midwives and two clinical trials practitioners who conducted trial recruitment.ResultsConsent procedures in the ACROBAT pilot trial were generally acceptable and the intervention was viewed as low risk, but most women did not remember much about the consent conversation. As per trial protocol, recruiters sought to consent women before hospital discharge, but this time pressure had to be balanced against the need to ensure women were not approached when distressed or very unwell. Extra efforts had to be made to communicate trial information to women due to the exhaustion of their recovery and competing demands for their attention. Participant information was further complicated by explanations about the cluster design and change in transfusion process, even though the consent sought was for access to medical data.ConclusionOur findings indicate that deferred consent procedures raise similar concerns as taking consent when emergency obstetric research is occurring—that is, the risk that participants may conflate research with clinical care, and that their ability to process trial information may be impacted by the stressful nature of recovery and newborn care. A future trial may support more meaningful informed consent by extending the window of consent discussion and ensuring trial information is minimal and easy to understand.Trial registration numberISRCTN12146519.

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Aim: Manometry is the best established technique to assess anorectal function in faecal incontinence. By systematic review, pooled prevalences of anal hypotonia/hypocontractility and rectal hypersensitivity/hyposensitivity in male and female patients were determined in controlled studies using anorectal manometry.Methods: Searches of MEDLINE and Embase were completed. Screening, data extraction and bias assessment were performed by two reviewers. Meta-analysis was performed based on a random effects model with heterogeneity evaluated by I 2 .Results: Of 2116 identified records, only 13 studies (2981 faecal incontinence patients; 1028 controls) met the inclusion criteria. Anal tone was evaluated in 10 studies and contractility in 11; rectal sensitivity in five. Only three studies had low risk of bias. Pooled prevalence of anal hypotonia was 44% (95% CI 32-56, I 2 = 96.35%) in women and 27% (95% CI 14-40, I 2 = 94.12%) in men. The pooled prevalence of anal hypocontractility was 69% (95% CI 57-81; I 2 = 98.17%) in women and 36% (95% CI 18-53; I 2 = 96.77%) in men. Pooled prevalence of rectal hypersensitivity was 10% (95% CI 4-15; I 2 = 80.09%) in women and 4% (95% CI 1-7; I 2 = 51.25%) in men, whereas hyposensitivity had a pooled prevalence of 7% (95% CI 5-9; I 2 = 0.00%) in women compared to 19% (95% CI 15-23; I 2 = 0.00%) in men. Conclusions:The number of appropriately controlled studies of anorectal manometry is small with fewer still at low risk of bias. Results were subject to gender differences, wide confidence intervals and high heterogeneity indicating the need for international collective effort to harmonize practice and reporting to improve certainty of diagnosis.

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IntroductionTo compare anal sphincter pressure parameters using water-perfused (WP) and a solid-state (SS) HRAM catheter in healthy volunteers using a standardised protocol to provide normal values.Methods60 asymptomatic volunteers were studied (20 M/40 F). WP HRAM single-use ano-rectal catheters (ARC), 10 channels, external diameter 14 Fr (MUI Scientific, Canada) and SS HRAM multi-use ARC, 8 channels placed 0.8 cm apart, external diameter of 12 Fr, 16 Fr at sensors (UniSensor AG, Switzerland) both distributed by Ardmore Healthcare, UK. Studies were performed consecutively in a randomised order with the volunteers in the left-lateral position with knees & hips flexed. After a 3 minute familiarisation period, the following test manoeuvres were performed according to a standardised protoco,1 Rest- subject relaxed and lying still, anorectal pressures measured for 1 minute. Cough- asked to cough once maximally. Squeeze- asked to squeeze maximally for 5 seconds. Cough & squeeze manoeuvres were repeated twice. Sensation of maximum rectal capacity was assessed by gradual inflation of the balloon at a rate of 2 ml/sec using an automated pump.ResultsNormal values (5 th-95th percentile) for parameters of ano-rectal function in males & females using.Abstarct PTU-118 Table 1 Males: SS HRAM: WP HRAM:Anal canal length (cm)3.0-5.02.8-5.3Resting pressure (mmHg)50.3-115.542.1-104Cough increment (mmHg)70.5-364.431.5-147.6Squeeze increment (mmHg)76.0-527.638.1-301.5Max tolerated volume (ml)99.5-276.3120.1-250 Females: SS HRAM: WP HRAM:Anal canal length (cm)1.9-4.21-7-3.5Resting pressure (mmHg)25.6-94.533.4-101.9Cough increment (mmHg)43.3-259.527.8-136.3Squeeze increment (mmHg)34.5-332.827.2-188.5Max tolerated volume (ml)87.6-236.480.2-233.4ConclusionSignificant differences between the two systems were observed for maximum squeeze increment and maximum cough increment in males & females (p < 0.001). There was no significant difference between the two catheter types in relation to anal canal length, resting pressure or maximum tolerated volume. This study utilised the same manometry system to record and analyse results, making it the first study to directly compare the impact of catheter choice on HRAM in normal volunteers.Reference1 Carrington EV, et al. Traditional measures of normal anal sphincter function using HRAM) in 115 healthy volunteers. Neurogastro & Motility 2014;26(5):625–635.Disclosure of InterestNone Declared