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Comparison of Anorectal Function as Measured with High-Resolution and High-Definition Anorectal Manometry
Marcin Banasiuk1, Magdalena Elżbieta Dobrowolska1, Barbara Skowrońska1
1Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
Insights
Different anorectal manometry catheters yield varying pressure readings in children with functional defecation disorders. Standard pressure ranges are not interchangeable between 2D and 3D systems, requiring specific calibration for accurate diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Technology Assessment
Background:
- Anorectal manometry (ARM) assesses rectal and anal canal pressure, but results may vary based on the catheter used.
- Accurate pressure measurements are crucial for diagnosing functional anorectal disorders in children.
Purpose of the Study:
- To compare anorectal manometry results obtained using different catheter types in pediatric patients.
- To evaluate the impact of 2D versus 3D catheter technology on pressure measurements and diagnostic accuracy for functional defecation disorders.
Main Methods:
- Prospective enrollment of 100 children diagnosed with functional defecation disorders (Rome IV criteria).
- Sequential ARM using both high-resolution (2D) and high-definition (3D) catheters in a randomized order.
- Comparison of resting pressure, squeeze pressure, and bear-down maneuver variables between the two catheter types.
Main Results:
- Mean resting pressures were significantly higher with the 3D catheter (71 mm Hg) compared to the 2D catheter (65 mm Hg) (p=0.000).
- The percentage of anal relaxation was higher with the 3D probe (12%) than the 2D probe (5%) (p=0.002).
- Diagnosis of dyssynergic defecation differed between catheters (57.7% with 3D vs. 71.8% with 2D), showing only fair agreement (κ=0.40).
Conclusions:
- Significant differences in pressure values were observed between 2D and 3D anorectal manometry catheters.
- Conventional manometry normal ranges are not applicable to high-resolution systems.
- Results from different manometry types require adjustments for valid comparison and accurate diagnosis.
Introduction:
Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in the rectum and anal canal. Absolute pressure values might depend on the catheter used.
Objective:
Our aim was to compare the results obtained by different anorectal catheters in children with functional anorectal disorders.
Methods:
Children diagnosed with functional defecation disorders based on the Rome IV criteria were prospectively enrolled. ARM was performed in the supine position successively using 2 different probes in each patient in random order. Resting, squeeze pressures, and bear-down maneuver variables obtained by high-resolution (2-dimensional [2D]) and high-definition (3-dimensional [3D]) catheters were compared.
Results:
We prospectively included 100 children {mean age 7.5 [standard deviation (SD) ± 4.3] years; 62 boys}. Mean resting pressures were significantly higher when measured with the 3D than with the 2D catheter (71 [SD ± 19.4] vs. 65 [SD ± 20.1] mm Hg, respectively; p = 0.000). Intrarectal pressure measured by 3D and 2D catheters was similar (35 vs. 39 mm Hg, respectively; p = 0.761), but the percent of anal relaxation appeared to be higher for the 3D than for the 2D probe (12 vs. 5%, respectively; p = 0.002). Dyssynergic defecation (DD) was diagnosed in 41/71 patients (57.7%) using the 3D probe and in 51/71 children (71.8%) using the 2D probe (p = 0.044). Cohen's kappa showed only fair agreement between the catheters (κ = 0.40) in diagnosis of DD.
Conclusions:
Our study demonstrated significantly different values of pressures obtained with different types of catheters. Normal ranges for conventional manometry cannot be applied to high-resolution systems, and results obtained by different types of manometry cannot be compared without adjustments (NCT02812823).
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