Comparison of High-resolution Anorectal Manometry With Water-perfused Anorectal Manometry

Abstract

Background/Aims To date, high-resolution manometry has been used mainly in the study of esophageal motility disorders and has been shown to provide more physiological information than conventional manometry, and is easier to interpret. This study aimed to evaluate the usefulness of high-resolution anorectal manometry (HRARM) compared to water-perfused anorectal manometry. Methods Patients who complained of chronic constipation with/without fecal incontinence underwent both water-perfused anorectal manometry and HRARM in a random order on the same day. Resting and squeezing pressures of the anal sphincter, attempted defecation, rectoanal inhibitory reflex, rectoanal contractile reflex, Rao’s type of dyssynergia during attempted defecation, anal canal length, defecation dynamic parameters and measurement times for each method were analyzed. Results Of 14 patients, 7 were female, and the median age was 59 years (range 35–77). Indications for manometry were constipation (n = 8) and constipation with fecal incontinence (n = 6). Resting and squeezing pressures showed that the 2 methods were strongly correlated (resting pressure: r = 0.746, P = 0.002; squeezing pressure: r = 0.921, P < 0.001). In attempted defection, one equivocal case with water-perfused anorectal manometry was diagnosed type I pelvic floor dyssynergia with HRARM providing detailed pressure changes in internal and external anal spincters, and puborectalis muscle which improved assessment of anorectal disorders. The measurement time for HRARM was significantly shorter than that for water-perfused anorectal manometry (11.3 vs 23.0 minutes, P < 0.001). Conclusions Both water-perfused anorectal manometry and HRARM are well tolerated and reliable methods of evaluating defecation disorders of pelvic floor dysfunction. HRARM is likely to provide better physiological information and to require a shorter measurement time compared to water-perfused anorectal manometry.

How to Perform and Interpret a High-resolution Anorectal Manometry Test

“…However, recent observations with esophageal ManoScan catheters suggest that this pressure drift is related to "average pressure exposure" of a sensor during the study procedure and may not be adequately corrected with the thermal compensation algorithm. 14 In addition, while pressures recorded with HR-ARM and non-high resolution manometry are significantly correlated, [9][10][11]15 anal sphincter pressures at rest and during anal contraction (ie, squeeze maneuver) tend to be higher when measured with HR-ARM than when measured with non-high resolution manometry. [9][10][11] The rectoanal pressure gradient measured with both techniques was also strongly correlated; however the gradient was more negative for non-high resolution (-66 mmHg) than HR-ARM, 10 even in healthy women.…”

“…The anal pressure change during cough reflex was recorded 10 mmHg greater by HR-ARM than non-HRM; the difference between 2 methods was not statistically significant. 11 …”

“…HR-ARM and HD-ARM catheters provide a continuous and dynamic spatiotemporal mapping of anorectal pressures, allowing easier and more detailed data interpretation. [9][10][11][12] While HR-ARM and HD-ARM both measure pressures around the circumference of the catheter, only HD-ARM provides the pressures measured by individual sensors around the catheter circumference. 12,13 The duration of the examination is also significantly shorter with HR-ARM than with non-HRM because the former does not require a pull-through procedure, and the topographic display enables rapid positioning of the probe.…”

“…12,13 The duration of the examination is also significantly shorter with HR-ARM than with non-HRM because the former does not require a pull-through procedure, and the topographic display enables rapid positioning of the probe. 10,11 However, HR-ARM and HD-ARM catheters are more expensive and fragile than non-high resolution catheters and have a shorter lifespan. 12 For example, ManoScan catheters are guaranteed for 200 uses only.…”

Common Tests for the Pelvic Floor

“…This can lead to improved understanding of the anal canal function. When compared to water perfused systems, highresolution anal manometry was found to correlate well with respect to pressure measurements, but was noted to have decreased variability during the dynamic portions of the study as well as decreased time to perform the study [ 81 ]. Some have noted an increase in measured resting and squeeze pressure using the high-resolution probe compared to the water perfused probe.…”