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Utility of Colon Manometry in Guiding Therapy and Predicting Need for Surgery in Children With Defecation Disorders
Leonel Rodriguez1, Nicole Heinz, Samuel Nurko
1Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Insights
Colon manometry (CM) is useful for pediatric defecation disorders. An abnormal CM predicts surgery but not successful medical treatment, guiding its use when surgery is considered.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Diagnostic Procedures
Background:
- Colon manometry (CM) is increasingly used to evaluate pediatric defecation disorders.
- Its utility in guiding therapy and predicting surgical outcomes requires further investigation.
Purpose of the Study:
- To assess the effectiveness of colon manometry in guiding therapeutic interventions for pediatric constipation.
- To determine if colon manometry can predict the need for surgical intervention in children.
Main Methods:
- A retrospective review of 555 colon manometry studies (448 patients) for indications including constipation and fecal incontinence.
- Analysis of gastrocolonic response (GC) and high-amplitude propagating contractions (HAPCs) in relation to therapeutic outcomes and surgical predictions.
Main Results:
- Therapy changes guided by CM showed a high response rate (P = 0.003).
- An abnormal CM was predictive of surgery (P < 0.01), while GC and HAPCs were not consistently associated with treatment response or surgical prediction.
- Partially propagated HAPCs were predictive of surgery (P < 0.001).
Conclusions:
- Colon manometry is valuable for pediatric defecation disorders, particularly in predicting surgical necessity.
- CM is not predictive of successful medical intervention and should be reserved for cases where medical treatments have failed and surgery is contemplated.
Objectives:
Colon manometry (CM) has emerged as a tool to evaluate children with defecation problems. Our aim was to evaluate the utility of CM in guiding therapy and predicting surgery in pediatric constipation.
Methods:
Retrospective review of children undergoing CM for 4 indications: constipation, fecal incontinence, postsurgical evaluation and chronic intestinal pseudo-obstruction. Variables included age, sex, follow-up, and CM parameters: gastrocolonic response (GC) and quality/quantity of high-amplitude propagating contractions (HAPCs).
Interventions:
medical, surgical or no intervention.
Outcomes:
response to change of therapy guided by CM, response to first intervention guided by CM (CMI) and CM predicting surgery (CMS). Response to therapy was classified according to study indication.
Results:
Five hundred fifty-five studies (448 patients, 54.4% female; median age 8.9 years) were included, 24% of studies were normal. Change of therapy guided by CM was associated with a high response rate (P = 0.003). Overall response to stimulant laxatives was 48% and was not associated with CM findings. Surgical interventions had a higher response rate than medical or other interventions (P < 0.001). We found no association between the CM interpretation and CMI, but an abnormal CM was predictive of surgery (P < 0.01). GC and presence/number of HAPCs were not associated with CMI or CMS. We also found no association between HAPC quality and CMI but partially propagated HAPCs were predictive of surgery (P < 0.001). Logistic regression analysis showed no factors associated with CMI; however, longer follow up and partially propagated HAPCs were predictive of surgery.
Conclusions:
CM is useful in pediatric defecation disorders, although not predictive of successful medical intervention, an abnormal CM is predictive of surgery. CM should be performed only after medical interventions have failed and surgery is contemplated.
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