Staying in HRAM’s Way: Tweaking the London Classification for Disorders of Anorectal Function

Bellini, Massimo; Chiarioni, Giuseppe

doi:10.1007/s10620-021-06995-3

Cited by 2 publications

(2 citation statements)

References 7 publications

(9 reference statements)

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“…Regarding push maneuvers, we did not explore 3D parameters as useful markers to differentiate pelvic dyssynergia or predict BET as studied with IPV [11], due to the imprecise delimitation of component extension of the rectal ampulla and anal canal and their 3D manometric dynamic interactions found, constituting a gap of our results. Our complementary parameters findings showed negative values of rectum-anal gradient without rectal distension and no difference to gender, and evaluating anal canal relaxation we found in the men group a lowest and negative value (p<0.05), whose potential explanations have been discussed for previous studies [6,18], emphasizing that the search for another manometric marker to constipated seems relevant.…”

Section: D Manometric Parameterssupporting

confidence: 69%

“…Several studies have aimed to determine normal values of anorectal HRM and to demonstrate equivalent manometric findings, however, under a range of variables. Distinct pressure-sensing transducer systems, solid state or water-perfused, in high-resolution or high-definition, combined with different circumferential settings probes, in distribution and sensors number [4,5], whose results also affected by non-standard technical procedures [5,6].…”

Section: Introductionmentioning

confidence: 99%

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London Protocol under water-perfused HRM in a healthy population, towards novel 3D manometric parameters in an evaluation of anorectal functional disorders

Anefalos,

Martinez,

Coy

2024

BMC Gastroenterol

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Background/Aim London Protocol (LP) and Classification allied to high-resolution manometry (HRM) technological evolution has updated and enhanced the diagnostic armamentarium in anorectal disorders. This study aims to evaluate LP reproducibility under water-perfused HRM, provide normal data and new parameters based on 3D and healthy comparison studies under perfusional HRM. Methods Fifty healthy (25 F) underwent water-perfused 36 channel HRM based on LP at resting, squeeze, cough, push, and rectal sensory. Additional 3D manometric parameters were: pressure-volume (PV) 104mmHg2.cm (resting, short and long squeeze, cough); highest and lowest pressure asymmetry (resting, short squeeze, and cough). Complementary parameters (CP) were: resting (mean pressure, functional anal canal length); short squeeze (mean and maximum absolute squeeze pressure), endurance (fatigue rate, fatigue rate index, capacity to sustain); cough (anorectal gradient pressure); push (rectum-anal gradient pressure, anal canal relaxation percent); recto-anal inhibitory reflex (anal canal relaxation percent). Results No difference to genders: resting (LP, CP, and 3D); short squeeze (highest pressure asymmetry); endurance (CP); cough (CP, highest and lowest pressure asymmetry); push (gradient pressure); rectal sensory. Higher pressure in men: short squeeze (maximum incremental, absolute, and mean pressure, PV, lowest pressure asymmetry); long squeeze (PV); cough (anal canal and rectum maximum pressure, anal canal PV); push (anal canal and rectum maximum pressure). Anal canal relaxation was higher in women (push). Conclusions LP reproducibility is feasible under water-perfused HRM, and comparative studies could bring similarity to dataset expansion. Novel 3D parameters need further studies with healthy and larger data to be validated and for disease comparisons. Key points • London Protocol and Classification allied with the technological evolution of HRM (software and probes) has refined the diagnostic armamentarium in anorectal disorders. • Novel 3D and deepening the analysis of manometric parameters before the London Classification as a contributory diagnostic tool. • Comparison of healthy volunteers according to the London Protocol under a perfusional high-resolution system could establish equivalence points.

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Section: D Manometric Parameterssupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

London Protocol under water-perfused HRM in a healthy population, towards novel 3D manometric parameters in an evaluation of anorectal functional disorders

Anefalos,

Martinez,

Coy

2024

BMC Gastroenterol

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London Protocol under water-perfused HRM in a healthy population, towards novel 3D manometric parameters in an evaluation of anorectal functional disorders

ANEFALOS,

Martinez,

Coy

2024

Preprint

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Background/Aim London Protocol (LP) and Classification allied to high-resolution manometry (HRM) technological evolution has updated and enhanced the diagnostic armamentarium in anorectal disorders. This study aims to evaluate LP reproducibility under water-perfused HRM, provide normal data and new parameters based on 3D and healthy comparison studies under perfusional HRM. Methods 50 healthy (25 F) underwent water-perfused 36 channel HRM based on LP at resting, squeeze, cough, push, and rectal sensory. Additional 3D manometric parameters were: pressure-volume (PV) 10⁴mmHg².cm (resting, short and long squeeze, cough); highest and lowest pressure asymmetry (resting, short squeeze, and cough). Complementary parameters (CP) were: resting (mean pressure, functional anal canal length); short squeeze (mean and maximum absolute squeeze pressure), endurance (fatigue rate, fatigue rate index, capacity to sustain); cough (anorectal gradient pressure); push (rectum-anal gradient pressure, anal canal relaxation percent); recto-anal inhibitory reflex (anal canal relaxation percent). Results No difference to genders: resting (LP, CP, and 3D); short squeeze (highest pressure asymmetry); endurance (CP); cough (CP, highest and lowest pressure asymmetry); push (gradient pressure); rectal sensory. Higher pressure in men: short squeeze (maximum incremental, absolute, and mean pressure, PV, lowest pressure asymmetry); long squeeze (PV); cough (anal canal and rectum maximum pressure, anal canal PV); push (anal canal and rectum maximum pressure). Anal canal relaxation was higher in women (push). Conclusions LP reproducibility is feasible under water-perfused HRM, and comparative studies could bring similarity to dataset expansion. Novel 3D parameters need further studies with healthy and larger data to be validated and for disease comparisons.

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Staying in HRAM’s Way: Tweaking the London Classification for Disorders of Anorectal Function

Cited by 2 publications

References 7 publications

London Protocol under water-perfused HRM in a healthy population, towards novel 3D manometric parameters in an evaluation of anorectal functional disorders

London Protocol under water-perfused HRM in a healthy population, towards novel 3D manometric parameters in an evaluation of anorectal functional disorders

London Protocol under water-perfused HRM in a healthy population, towards novel 3D manometric parameters in an evaluation of anorectal functional disorders

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