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Utility of Monitoring Fasting Phase During Pediatric Colonic Manometry Studies
Lev Dorfman1, Khalil El-Chammas1,2, Sahana Khanna1
1Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Shortening the fasting phase of colonic manometry (CM) minimally impacts results. This adjustment can reduce patient discomfort and healthcare costs associated with pediatric gastrointestinal motility studies.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
- Diagnostic Procedures
Background:
- Colonic manometry (CM) assesses pediatric patients with complex bowel issues.
- Pan-colonic high-amplitude propagated contractions (HAPCs) indicate normal colon neuromuscular function.
- Current CM guidelines suggest a 1-2 hour fasting phase, but its diagnostic value is unproven.
Purpose of the Study:
- To evaluate the diagnostic utility of the fasting phase during colonic manometry (CM) studies.
- To determine if shortening the fasting period affects CM results.
- To identify potential benefits of optimizing CM protocols for pediatric patients.
Main Methods:
- Retrospective analysis of 433 colonic manometry (CM) studies from a tertiary pediatric center (2018-2022).
- Evaluation of the fasting phase recordings within normal CM studies.
- Assessment of high-amplitude propagated contractions (HAPCs) during the fasting period.
Main Results:
- In 433 studies, 28.4% showed pan-colonic HAPCs during the fasting phase, with 2.5% solely identified during this period.
- Pan-colonic HAPCs during fasting were more common in younger children and correlated with postprandial HAPCs.
- Most fasting pan-colonic HAPCs occurred within the first 60 minutes; shortening the fasting phase minimally impacted overall study classification.
Conclusions:
- The fasting phase of colonic manometry (CM) may be shortened without significantly compromising diagnostic accuracy.
- Optimizing the fasting duration can enhance patient experience and reduce healthcare resource utilization.
- Further research could refine CM protocols to improve efficiency and patient comfort in pediatric evaluations.
Introduction:
Colonic manometry (CM) is a diagnostic procedure used to evaluate pediatric patients with refractory constipation, fecal incontinence, Hirschsprung disease, and pediatric intestinal pseudo-obstruction. Pan-colonic high-amplitude propagated contractions (HAPCs), measured by CM, reflect an intact neuromuscular function of the colon. Current guidelines recommend starting CM with fasting recording for 1-2 h, but no prior evaluation has determined the diagnostic yield of the fasting phase. We aimed to determine the utility of the fasting phase during CM studies.
Methods:
We evaluated CM studies conducted at a tertiary pediatric center (2018-2022). Fasting phases of normal CM studies were evaluated.
Key Results:
In 433 included studies 241 (55.7%) females, median age (9.7 years), the average fasting recording lasted 126 min. A total of 193 (44.6%) studies exhibited fasting HAPCs, with 123 (28.4%) being pan-colonic. The presence of pan-colonic HAPCs was based solely on the fasting phase in 11 (2.5%) studies. Patients with fasting pan-colonic HAPCs were younger (median age of 6.9 vs. 9.8 years, p = 0.0001) and had a higher rate of postprandial HAPCs (69.1% vs. 25.2%, p < 0.0001). Most fasting pan-colonic HAPCs presented during the first 60 min (94/123, 76.4%). All studies demonstrated HAPCs after stimulation with bisacodyl. In analyzing just the initial 30 min of fasting on CM, only 2 (0.5%) studies would have been misclassified as abnormal, with no bisacodyl administration in these studies.
Conclusions & Inferences:
Shortening the fasting phase minimally affects next-day CM results and could reduce patient inconvenience, hospital-related costs, and potential side effects.
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