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Related Experiment Videos

Dynamic evaluation of the anorectum.

Clive Bartram1

  • 1Imperial College Faculty of Medicine and Department of Intestinal Imaging, St. Mark's Hospital, Northwick Park Harrow HA1 3UJ, United Kingdom. c.bartram@ic.ac.uk

Radiologic Clinics of North America
|March 28, 2003
PubMed
Summary

Evacuating proctography (EP) aids in diagnosing functional bowel disorders like anismus and rectal prolapse. Despite challenges, EP provides crucial information for complex patient management when other methods fail.

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Area of Science:

  • Gastroenterology
  • Radiology
  • Colorectal Surgery

Background:

  • Evaluating functional bowel disease presents challenges due to the absence of a gold standard and evolving treatment protocols.
  • A subset of patients with functional bowel disorders remains difficult to manage, necessitating comprehensive diagnostic information.
  • The clinical relevance and interobserver reliability of evacuative proctography (EP) have been debated, with some studies reporting low accuracy and others high diagnostic yield.

Purpose of the Study:

  • To assess the clinical utility and diagnostic value of evacuative proctography (EP) in managing patients with functional bowel disorders.
  • To determine how EP findings influence clinical decision-making and treatment strategies.
  • To highlight the conditions uniquely diagnosed by EP and its role in complex cases.

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Main Methods:

  • Review of existing literature and clinical case studies evaluating EP.
  • Analysis of reported observer accuracy and diagnostic yield of EP.
  • Examination of questionnaire data on clinician-perceived benefits of EP in patient management.

Main Results:

  • EP evaluation is complicated by the lack of a gold standard and shifting clinical focus.
  • While criticized for relevance and reliability, some studies report high observer accuracy (83.3%) and diagnostic yield.
  • Clinicians reported major benefit from EP in 40% of cases, influencing treatment from surgical to medical (14%) and vice versa (4%).

Conclusions:

  • Evacuative proctography (EP) is invaluable for diagnosing specific conditions like anismus, rectocele trapping, internal anal intussusception (IAI), and rectal prolapse.
  • EP is often the sole diagnostic method for certain functional bowel disorders.
  • Within defined parameters, EP significantly aids clinical management, particularly for challenging patient cases.