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Anal sphincter function as assessed by 3D high definition anorectal manometry
François Mion1, Aurélien Garros2, Fabien Subtil3
1Hospices civils de Lyon, exploration fonctionnelle digestive, hospital E.-Herriot, Lyon, France; Physiology department, université de Lyon, Lyon, France; Lab Tau, Inserm U1032, Lyon, France.
Clinics and Research in Hepatology and Gastroenterology
|March 20, 2018
Summary
High-definition anorectal manometry (HDARM) effectively distinguishes between constipation and fecal incontinence. Mean anal pressure during sustained squeeze is the most reliable HDARM parameter for differentiating these conditions.
Area of Science:
- Gastroenterology
- Physiology
- Medical Technology
Background:
- High-resolution anorectal manometry (HRAM) and 3D high-definition manometry (HDARM) have advanced anal sphincter function assessment.
- The clinical utility of HDARM parameters in differentiating anorectal disorders requires further investigation.
Purpose of the Study:
- To evaluate the discriminatory capacity of various HDARM parameters in distinguishing between patients with chronic constipation and fecal incontinence.
- To determine the most effective HDARM parameter for clinical application in these patient groups.
Main Methods:
- One hundred and fourteen patients underwent a standardized HDARM protocol involving short and sustained voluntary anal contractions.
- Anal sphincter function parameters, including resting and squeeze pressures, were analyzed using automated software.
- Receiver operating characteristic (ROC) curves were employed to assess the discriminative ability of HDARM parameters.
Main Results:
- All measured HDARM parameters showed high correlation.
- Mean anal pressure during sustained squeeze emerged as the most significant discriminant variable.
- The 3D lambda aspect of the anal sphincter was not significantly different between constipation and incontinence groups.
- A significant correlation was observed between the fecal incontinence Wexner score and voluntary contraction variables.
Conclusions:
- Mean anal pressure during sustained squeeze is the most discriminant HDARM parameter for differentiating constipation from fecal incontinence.
- HDARM shows promise for standardizing and simplifying the assessment of anal sphincter function.
- Further validation of HDARM parameters can aid in clinical decision-making for anorectal disorders.
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