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Expert consensus document: Advances in the evaluation of anorectal function.

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Area of Science:

  • Gastroenterology and Colorectal Surgery
  • Medical Imaging
  • Neurogastroenterology

Background:

  • Fecal incontinence and evacuation disorders significantly impact quality of life and incur high global economic costs.
  • Patient symptoms alone are insufficient predictors of the underlying pathophysiology and etiology.
  • Advances in technology have enhanced the understanding of anorectal structure, coordination, and sensorimotor function.

Purpose of the Study:

  • To provide an appraisal of current diagnostic tests for anorectal structure and function.
  • To outline the indications, performance characteristics, clinical utility, strengths, and limitations of these tests.
  • To establish a consensus on the clinical relevance of diagnostic investigations for fecal incontinence and evacuation disorders.

Main Methods:

  • Review and appraisal of established diagnostic tests for anorectal structure (ultrasonography, MRI) and function (anorectal manometry, neurophysiological investigations, rectal distension techniques, evacuation tests including defecography).
  • Consensus development based on current evidence and clinical expertise.

Main Results:

  • Detailed evaluation of the indications, performance characteristics, clinical utility, strengths, and limitations of various anorectal diagnostic tests.
  • Identification of key tests for assessing anorectal structure and function in patients with refractory symptoms.

Conclusions:

  • Diagnostic tests for anorectal function are crucial for managing patients with fecal incontinence and evacuation disorders refractory to conservative treatment.
  • This consensus statement offers guidance on the appropriate use and interpretation of these diagnostic modalities.
  • A comprehensive understanding of these tests aids in elucidating pathophysiology and guiding therapeutic decisions.