Magnetic resonance defecography versus videodefecography in the study of obstructed defecation syndrome: Is videodefecography still the test of choice after 50 years?

Abstract

MR defecography could become the imaging test of choice for evaluating obstructed defecation syndrome.

Systematic review with meta‐analysis: defecography should be a first‐line diagnostic modality in patients with refractory constipation

“…Furthermore, MRID appeared to underestimate the rectocele size, although it was able to detect a significant number of anatomical abnormalities missed on barium defecography in the anterior and middle pelvic floor compartments. Contrarily, however, higher MRID sensitivities for intussusception have been reported by the two most recent comparative studies . Nevertheless, pooled prevalence of the five comparative studies showed that barium defecography was superior to MRID in the detection of intussusception (57.8% vs 37.8%; OR: 1.52 [95% CI 1.12‐2.14, P = 0.009]), although the technique was associated with higher level of embarrassment (qualitatively measured among patients) and/or lower tolerance (54.3% vs 30.0%; OR: 1.73 [95% CI 1.14‐2.62, P = 0.008]) (Figure ).…”

“…Rectocele has traditionally been defined as an outpouching of the rectal wall on defecation . A total of 17/41 studies defined a cut‐off of rectocele depth to establish the diagnosis: 2 cm (n = 9); 2.5 cm (n = 1); 3 cm (n = 4); or 4 cm (n = 3) . However, the approach adopted to calculate rectocele size during maximum straining has been detailed in only nine of these as: (a) the “maximum depth of the bulge beyond the expected and extrapolated line of the anterior rectal wall” (n = 2); the “distance between the maximal anterior outbulge” and (b) the “axis of the anal canal” (n = 2), or (c) “a line through aspect of anorectal junction” (n = 1), or “a line drawn parallel to the center of the anal canal during straining” (n = 2); d) “outpouching of the anterior rectal wall ahead of rectovaginal septum, persisting on incomplete evacuation” (n = 2) …”

“…Among the 59 studies in patients with CC, diagnostic criteria and prevalence of functional abnormalities were provided in 42 (71%), based on either (a) (n = 22); (b) (n = 2); (c) (n = 2); (a + b) (n = 4); (a + c) (n = 7); (b + c) (n = 1); or (a + b+c) (n = 4) . Quantitative meta‐analysis of these studies, including four comparative (barium defecography vs MRID) studies, showed a pooled prevalence of 24.1% (95% CI, 20.2‐28.4) on barium defecography and 25.9 (14.1‐39.6) on MRID (Figure S6). The prevalence of functional abnormalities was lower in the comparative studies.…”

“…(b) (n = 2) 66,105 ; (c) (n = 2) 37,106 ; (a + b) (n = 4) 7,57,84,94 ; (a + c) (n = 7) 26,27,64,[107][108][109][110] ; (b + c) (n = 1) 85 ; or (a + b+c) (n = 4). 9,[111][112][113] Quantitative meta-analysis of these studies, including four comparative (barium defecography vs MRID) studies, 82,106 showed a pooled prevalence of 24.1% (95% CI, 20.2-28.4) on barium defecography and 25.9 (14.1-39.6) on MRID ( Figure S6). The prevalence of functional abnormalities was lower in the comparative studies.…”

El cuarto número del 2017 en NeuroGastroLATAM Reviews

“…Por su parte, Laura Solé presenta en el tercer artículo una revisión muy completa de la literatura de los últimos 10 años sobre los trastornos de la evacuación 11 . Si bien dichos trastornos se clasifican mediante los criterios de Roma IV 12 , requieren el uso de pruebas fisiológicas como manometría anorrectal, prueba de expulsión del balón y estudios de imagenología como defecografía convencional y por resonancia magnética (RM) [12][13][14] . Desde el punto de vista de los estudios de imagen, habrá que determinar si la defecografía por RM podrá reemplazar a la convencional, puesto que parece ser superior en la detección de enteroceles, pero presenta menor tasa de detección para rectoceles, intususcepción y descenso perineal 14 .…”