High‐resolution anorectal manometry: An expensive hobby or worth every penny?

Abstract

Introduced approximately 10 years ago, high-resolution manometry catheters have fostered interest in anorectal manometry. This review, which accompanies 2 articles in this issue of Neurogastroenterology and Motility, reviews the methods, clinical indications, utility, and pitfalls of anorectal manometry and revisits the American Gastroenterological Association (AGA) Medical Position Statement on Anorectal Testing Techniques, which was last published in 1999. High-resolution manometry provides a refined assessment of the anorectal pressure profile, obviates the need for station pull-through maneuvers, and minimizes movement artifacts. In selected cases, this refined assessment may be useful for identifying structural abnormalities or anal weakness. However, many manometry patterns that were previously regarded as abnormal are also observed in a majority of healthy patients, which substantially limits the utility of manometry for identifying defecatory disorders. It is our impression that most conclusions of the AGA medical position statement from 1999 remain valid today. High-resolution techniques have not substantially affected the number of publications on or management of anorectal disorders. The ongoing efforts of an international working group to standardize techniques for anorectal manometry are welcome. Although high-resolution manometry is more than an expensive hobby, improvements in catheter design and further research to rigorously define and evaluate these techniques are necessary to determine if they are worth every penny.

Clinical benefit of high resolution anorectal manometry for the evaluation of anal function after intersphincteric resection

“…Furthermore, because HR‐ARM catheters do not require either pull‐through manoeuvres or frequent sphincter contractions, they minimize movement‐related artifacts and are not affected by sphincter fatigue. These characteristics improve the consistency and accuracy of results irrespective of operator experience .…”

Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management

“…High resolution manometry enables measurement of both anal resting and squeeze pressures and the rectal pressure during simulated defaecation, and can therefore help in identifying DD 49 . However, many manometry patterns that were once considered abnormal have been observed in healthy asymptomatic individuals, which may limit utility 49 . It is important to correlate the result with patient symptoms, and careful clinical judgement must be exercised.…”

“…49 However, many manometry patterns that were once considered abnormal have been observed in healthy asymptomatic individuals, which may limit utility. 49 It is important to correlate the result with patient symptoms, and careful clinical judgement must be exercised. Defaecation proctography, traditionally using fluoroscopy and, more recently, magnetic resonance imaging, can elucidate obstructive causes of defaecation, such as rectal intussusception or rectocele.…”

High‐resolution anorectal manometry may probably be worth every penny

“…by Basilisco and Bharucha. 1 This paper summarizes the advantages and limits of this recent technique that has focused interest for the past 10 years. …”