Anorectal manometry in pediatric settings: A systematic review of 227 studies
Gregory Yates1,2, Florian Friedmacher1,2,3, Stewart Cleeve1,2
1Department of Paediatric Surgery, The Royal London Hospital, London, UK.
Insights
Anorectal manometry (ARM) use in children with constipation and incontinence varies widely. Standardization of ARM protocols is needed to improve understanding of pediatric defecation disorders.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Tools in Medicine
- Clinical Practice Variation
Background:
- Chronic constipation and functional/structural fecal incontinence (CCFSFI) in children present diagnostic challenges.
- Anorectal manometry (ARM) is a key functional assessment tool for the anorectum.
Purpose of the Study:
- To review current Anorectal Manometry (ARM) use in pediatric patients with CCFSFI.
- To analyze variations in ARM indications and protocols within pediatric practice.
Main Methods:
- Systematic review of empirical studies on pediatric ARM use.
- Literature search updated to October 2019, including data on demographics, clinical details, and ARM parameters.
- Analysis of sedation/anesthesia use during pediatric ARM.
Main Results:
- 227 studies included, with participants aged 0-18 years.
- ARM more frequently used for organic conditions (65%) than functional constipation (41%).
- Rests anal pressure and rectoanal inhibitory reflex were most commonly assessed parameters.
Conclusions:
- Significant variation exists in pediatric Anorectal Manometry (ARM) application.
- Standardization of ARM protocols and consensus guidelines are essential.
- Standardized ARM will enhance understanding of pediatric defecation disorders.
Background:
There is wide variation in the clinical use of diagnostic tools for children with chronic constipation and functional/structural fecal incontinence (CCFSFI). Anorectal manometry (ARM) is a well-recognized technique to assess the function of the anorectum.
Purpose:
Our aim was to perform an up-to-date review on ARM in pediatric patients with CCFSFI, with specific focus on the indication of use and protocol. Variation of its use in pediatrics will be explored.
Methods:
A systematic search was conducted for empirical studies utilizing ARM with a pediatric sample. A keyword search of literature published in English before July 2018 was conducted and updated to October 2019. Data on demographics, clinical information, study aims, ARM parameters and use of sedation/anesthesia were collected.
Key Results:
A total of 227 studies were included in this systematic review. The age of study participants at the time of ARM ranged from birth to 18 years. ARM was most commonly used in patients with organic conditions (65%) compared to functional constipation (41%). In almost half [108/227 (48%)] of the studies, ARM was performed awake. The ARM parameters most frequently assessed were the rectoanal inhibitory reflex, which was evaluated in 198/227 studies (87%) and the anal resting pressure [166/227 studies (73%)].
Conclusions And Inferences:
This systematic review has highlighted the vast variation of ARM use within pediatrics and the need to strive toward standardization and use of consensus guidelines. We anticipate this will further advance our understanding of the pathophysiological mechanisms involved in children with defecation disorders.
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