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Published on: April 17, 2019
Clinical utility of anal sphincter relaxation integral in water-perfused and solid-state high-resolution anorectal
Jia-Feng Wu1, Yu-Cheng Lin2, Chia-Hsiang Yang3
1Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Insights
The anal sphincter relaxation integral (ASRI) shows promise in diagnosing Hirschsprung
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Surgical Innovation
Background:
- Hirschsprung's disease (HD) is a congenital condition affecting the large intestine.
- Accurate and timely diagnosis is crucial for effective treatment in infants.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the anal sphincter relaxation integral (ASRI) for identifying Hirschsprung's disease (HD) in infants.
- To compare the performance of ASRI using both water-perfused and solid-state high-resolution anorectal manometry (HRAM) systems.
Main Methods:
- High-resolution anorectal manometry (HRAM) was performed on 36 infants (13 with HD).
- The ASRI was calculated during the rectoanal inhibitory reflex (RAIR) maneuver at two pressure cutoffs (<10 mmHg and <15 mmHg).
- Diagnostic performance metrics were analyzed for both water-perfused and solid-state HRAM systems.
Main Results:
- Infants with HD exhibited significantly lower ASRI values compared to non-HD infants (P < 0.05).
- For water-perfused HRAM, ASRI cutoffs of <7 mmHg·s·cm (ASRI 10) and <29 mmHg·s·cm (ASRI 15) showed 88.89% diagnostic performance for HD.
- For solid-state HRAM, optimal ASRI cutoffs were <5.5 mmHg·s·cm (ASRI 10) and <20 mmHg·s·cm (ASRI 15), yielding 83.33% diagnostic accuracy.
Conclusions:
- The ASRI is a potentially valuable tool for diagnosing Hirschsprung's disease in infants.
- Both water-perfused and solid-state HRAM systems can utilize ASRI for HD diagnosis.
- Specific ASRI cutoff values are necessary for each HRAM system to accurately predict HD.
Background/Purpose:
We investigated the diagnostic performance of the anal sphincter relaxation integral (ASRI) for infants with Hirschsprung's disease (HD).
Methods:
We performed water-perfused high-resolution anorectal manometry (HRAM) in 18 infants (9 with HD), and solid-state HRAM in another 18 infants (4 with HD). We calculated the ASRI during the rectoanal inhibitory reflex (RAIR) maneuver at pressure cutoffs of <10 mmHg (ASRI 10) and <15 mmHg (ASRI 15). We investigated the diagnostic performance of the ASRI for HD in infants undergoing water-perfused and solid-state HRAM.
Results:
HD infants who underwent either water-perfused or solid-state HRAM had significantly lower ASRI 10 and ASRI 15 values, compared with non-HD infants (P < 0.05 and P < 0.05, respectively). Using the water-perfused HRAM system, ASRI 10 and ASRI 15 values of <7 and <29 mmHg s.cm, respectively, exhibited good diagnostic performance for HD (88.89% and 88.89%, respectively). Receiver operating characteristic curve analysis indicated that ASRI 10 and ASRI 15 values of <5.5 and <20 mmHg s.cm, respectively, were optimal for the diagnosis of HD infants when using the solid-state HRAM system, with high diagnostic accuracies of 83.33% and 83.33%, respectively.
Conclusion:
ASRI may assist the diagnosis of HD infants using either water-perfused or solid-state HRAM. These systems require different catheter-specific ASRI cutoffs for the prediction of HD.
