Three‐dimensional high‐resolution anorectal manometry: does it allow automated analysis of sphincter defects?

Benezech, Alban; Behr, Michel; Bouvier, Michel; Grimaud, J. C.; Vitton, Véronique

doi:10.1111/codi.13017

Cited by 14 publications

(22 citation statements)

References 22 publications

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“…Two patients (5%) had a regional MRP < 10 mmHg in the FTA [ 15 , 16 ], 6 (15%) patients had regional MRP < 25 mmHg [ 17 ] and 21 (53%) patients had a regional MRP ≤ 50 mmHg.…”

Section: Resultsmentioning

confidence: 99%

“…These findings could be used to tailor surgical therapy. This concept is indirectly supported by the studies by Vitton et al, who found only a moderate correlation between the detection of sphincter defects with 3D-HRAM and EUS [ 16 , 17 ]. A recent study confirmed these results [ 18 ].…”

Section: Introductionmentioning

confidence: 83%

“…False positive rates, suggesting a defect with 3D-HRAM not confirmed by EUS were 21% and 30%. Automatic analysing software did not improve the detection rate [ 17 ]. Another study in 39 patients with a threshold of 25 mmHg with 18 o continuous expansion showed that sphincter defects on 3D-EUS were detected with 3D-HRAM in 6 out of 8 patients (75%) [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two different ways to identify FTA area on 3D-HRAM were tested: 1. absolute local MRP in the FTA, 2. difference in resting pressure between the FTA and its surrounding area (ΔMRP). Subsequently, the MRP in the FTA was categorized as a MRP < 10 mmHg, MRP < 25 mmHg and a MRP < 50 mmHg for comparison with the literature [ 15 – 17 ]. Alternatively, we considered a ΔMRP of ≥30 mmHg as good concordance between 3D-HRAM and 3D-EUS.…”

Section: Methodsmentioning

confidence: 99%

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3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound

et al. 2018

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BackgroundPerianal fistula surgery can damage the anal sphincters which may cause faecal incontinence. By measuring regional pressures, 3D-HRAM potentially provides better guidance for surgical strategy in patients with perianal fistulas. The aim was to measure regional anal pressures with 3D-HRAM and to compare these with 3D-EUS findings in patients with perianal fistulas.MethodsConsecutive patients with active perianal fistulas who underwent both 3D-EUS and 3D-HRAM at a clinic specialised in proctology were included. A group of 30 patients without fistulas served as controls. Data regarding demographics, complaints, previous perianal surgical procedures and obstetric history were collected. The mean and regional anal pressures were measured with 3D-HRAM. Fistula tract areas detected with 3D-EUS were analysed with 3D-HRAM by visual coding and the regional pressures of the corresponding and surrounding area of the fistula tract areas were measured. The study was granted by the VUmc Medical Ethical Committee.ResultsForty patients (21 males, mean age 47) were included. Four patients had a primary fistula, 19 were previously treated with a seton/abscess drainage and 17 had a recurrence after previously performed fistula surgery. On 3D-HRAM, 24 (60%) fistula tract areas were good and 8 (20%) moderately visible. All but 7 (18%) patients had normal mean resting pressures. The mean resting pressure of the fistula tract area was significantly lower compared to the surrounding area (47 vs. 76 mmHg; p < 0.0001). Only 2 (5%) patients had a regional mean resting pressure < 10 mmHg of the fistula tract area. Using a Δ mean resting pressure ≥ 30 mmHg difference between fistula tract area and non-fistula tract area as alternative cut-off, 21 (53%) patients were identified. In 6 patients 3D-HRAM was repeated after surgery: a local pressure drop was detected in one patient after fistulotomy with increased complaints of faecal incontinence.ConclusionsProfound local anal pressure drops are found in the fistula tract areas in patients normal mean resting pressures. Fistulotomy may affect local sphincter pressure. This might influence surgical decision making in future.

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“…Two patients (5%) had a regional MRP < 10 mmHg in the FTA [ 15 , 16 ], 6 (15%) patients had regional MRP < 25 mmHg [ 17 ] and 21 (53%) patients had a regional MRP ≤ 50 mmHg.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound

et al. 2018

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“…1). The technique is more intuitive and reproducible, and has better inter-observer agreement when compared to the conventional procedure (8,9). It is also easier to perform, as the whole study may be carried out without catheter mobilization, and more accurate regarding the relationship between balloon distension and motor response.…”

Section: Fig 1 Resting Anal Canal Pressure and Maximum Voluntary Comentioning

confidence: 99%

High-resolution and high-definition anorectal manometry: rediscovering anorectal function

Ríos¹,

Mínguez²,

Remes-Troche³

et al. 2018

Rev Esp Enferm Dig

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assess anorectal function provides highly significant information on the pathophysiological mechanisms involved in the genesis of fecal incontinence, pelvic floor dyssynergia, rectal hypo-or hypersensitivity, and pelvic neuropathy (3). Anorectal manometry (ARM) is a technique that, by simultaneously recording intraluminal pressure changes at multiple levels, allows to assess anorectal motor activity both at rest and mimicking multiple physiological situations (rectoanal inhibitory reflex, retention effort, defecation maneuver, Valsalva reflex). While barostat represent the gold standard in the evaluation of rectal sensitivity, ARM may also assess it provided the device is fitted with a distensible rectal balloon. This technique, together with balloon expulsion testing, is used in standard clinical practice for the diagnosis of defecatory disorders in patients with constipation refractory to standard therapy with hygienic-dietary measures and laxatives (4), in the assessment of patients with fecal incontinence (5), to administer biofeedback therapy to patients with constipation and/or fecal incontinence, in the assessment of anorectal pain syndromes (proctalgia), and even for the preoperative and postoperative evaluation of ileorectal anastomoses (6). High-resolution anorectal manometry (HR-ARM) and high-definition anorectal manometry (HD-ARM), available since 2007, are increasingly used in clinical practice. In comparison to the conventional technique, HR-ARM and HD-ARM catheters provide a greater number of recording points thanks to their multiple, closely packed circumferential sensors. This allows time-space visualization (topograph

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Role of Anorectal Manometry in Clinical Practice

Staller

2015

Curr Treat Options Gastro

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Physiologic assessment of the anorectum and pelvic floor by anorectal manometry and balloon expulsion testing provides important insights into the pathologic processes underlying defecatory disorders and guides treatment, specifically the use of biofeedback for the treatment of dyssynergic defecation and the identification of possible structural abnormalities of the pelvic floor. While symptoms and digital rectal examination may suggest pelvic floor dysfunction to the clinician, only pelvic floor testing provides definitive diagnoses of these often treatable abnormalities. The use of anorectal manometry in clinical practice is currently limited by substantial variation in performance of the test and interpretation of the results, but anorectal manometry with the addition of balloon expulsion test to improve specificity provides the best current modality for the diagnosis of dyssynergic defecation. With the introduction of high-resolution and three-dimensional, high-definition probes, our ability to characterize the structure and function of the anorectum has never been better, though further research is still needed to improve our ability to diagnose pelvic floor dysfunction and refer appropriate patients to treatment. In areas where the availability of anorectal manometry (ARM) is limited, a thorough digital rectal exam performed by an experienced clinician plus the balloon expulsion test alone may identify appropriate patients to refer for additional testing. This review describes the appropriate indications for and appropriate performance of anorectal manometry in clinical practice with an eye toward the diagnosis of dyssynergic defecation in patients with chronic constipation, fecal incontinence, and chronic proctalgia.

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Three‐dimensional high‐resolution anorectal manometry: does it allow automated analysis of sphincter defects?

Abstract: Our study developed a method based on 3D-HRAM to automatically diagnose sphincter defects, allowing a systematic and comprehensive analysis of the test recordings. Compared with EUS, the 3D-HRAM image analysis procedure revealed poor sensitivity and specificity.

Cited by 14 publications

References 22 publications

3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound

3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound

High-resolution and high-definition anorectal manometry: rediscovering anorectal function

Role of Anorectal Manometry in Clinical Practice

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