Anatomy and mechanical properties of the anal sphincter muscles in healthy senior volunteers

Brusa, Tobia; Abler, Daniel; Tutuian, Radu; Gingert, Christian; Heverhagen, Johannes T.; Adamina, Michel; Brügger, Lukas; Büchler, Philippe

doi:10.1111/nmo.13335

Cited by 4 publications

(9 citation statements)

References 20 publications

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“…While the methodology used was quite similar among all studies, there is until now, no consensus about the best parameters to record with FLIP technology. Several parameters have been suggested from the most complexes (anal canal stiffness defined on the basis of the pressure and diameter changes when the volume increased from 1 to 50 mL, 93‐95 flow resistance of the anal canal defined from the anal canal length, the middle part diameter of the anal canal and the dynamic viscosity of the inflated bag 96 or mechanical work of the anal sphincter muscle, 97 to the most simple (wall tension (T = P.r), 98 anal DI (CSA/P), 99,100 anal compliance (D/P), 97 yield pressure when the most resistant (middle) part of the sphincter begins to distend 93‐95 . More recently, Zifan et al described the use of area‐pressure and area‐tension‐loop analysis of the anal sphincters and puborectalis muscles in normal subjects and fecal incontinent patients, assessing the relationship between changes in muscle length (secondary to anal distension) and muscle function 101,102 .…”

Section: Resultsmentioning

confidence: 99%

“…More recently, Zifan et al described the use of area‐pressure and area‐tension‐loop analysis of the anal sphincters and puborectalis muscles in normal subjects and fecal incontinent patients, assessing the relationship between changes in muscle length (secondary to anal distension) and muscle function 101,102 . Thus, although 10 studies have reported results of FLIP measurements in the anal canal in HV, 93,95,97‐99,101,103‐105 no reliable normal values are yet available because of the absence of standardized protocols for assessing and analyzing FLIP measurements. However, some of these studies have demonstrated that the geometry of the lumen and the biomechanical properties of the anal canal are not uniform during distension.…”

Section: Resultsmentioning

confidence: 99%

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The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

Desprez

Roman

Leroi

et al. 2020

Neurogastroenterology Motil

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Background and purpose The EndoFLIP® system is a method of delineating impedance and was first designed to investigate the characteristics of the esophago‐gastric junction. In the last decade, its use was widened to investigate other sphincteric and non‐sphincteric systems of the gastrointestinal tract. The objective of the present systematic review was to summarize the available data in literature on the use of the EndoFLIP® system in the gastrointestinal tract, including sphincteric and non‐sphincteric regions. We performed a systematic review in accordance with recommendations for systematic review using PRISMA guidelines without date restriction, until June 2020, using MEDLINE‐PubMed, Cochrane Library, and Google Scholar databases. Only articles written in English were included in the present review. Five hundred and six unique citations were identified from all database combined. Of those, 95 met the inclusion criteria. There was a lack of standardization among studies in terms of anesthetic drugs use, probe placement, and inflation protocol. In most cases, only small cohorts of patients were included. Most studies investigated the EGJ, with a potential use of the EndoFLIP® to identify a subgroup of patients with achalasia and for intraoperative assessment of treatment efficacy in achalasia. However, the use of EndoFLIP® in the esophageal body (esophageal panometry), other esophageal diseases (gastro‐esophageal reflux disease, eosinophilic esophagitis), and other sphincter regions (anal canal, pylorus) will need further confirmatory studies. The EndoFLIP® system provides detailed geometric data of the gastrointestinal lumen but further works are needed to determine its use in clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

Desprez

Roman

Leroi

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“…They confirmed the least compliant portion of the anal canal was at the proximal end of the EAS, where it overlaps the IAS and puborectalis, highlighting this area's role in the maintenance of continence 35 . This area also demonstrated the maximal orifice closing function during voluntary squeeze, with the thickness of the EAS correlating with the change in orifice radius during contraction 54 …”

Section: Functional Lumen Imaging Probementioning

confidence: 81%

Current and future perspectives on the utility of provocative tests of anal sphincter function: A state‐of‐the‐art summary

O'Connor

Byrne

Vasant

et al. 2022

Neurogastroenterology Motil

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Background:The maintenance of fecal continence depends upon coordinated interactions between the pelvic floor, anorectum, and anal sphincter complex orchestrated by central and peripheral neural activities. The current techniques to objectively measure anorectal function rely on fixed diameter catheters placed inside the anal canal with a rectal balloon to obtain measurements of anal resting and squeeze function, and rectal compliance. Until recently it had not been possible to measure the distensibility of the anal canal, or in other words its ability to resist opening against an increasing pressure, which has been proposed as the main determinant of a biological sphincter's function. Anal acoustic reflectometry (AAR) and the functional lumen imaging probe (FLIP) are two novel, provocative techniques that dynamically assess the anal sphincter complex under volume-controlled distension. In doing so, both provide information on the viscoelastic properties of the anal canal and offer new insights into its function.Purpose: This review details the current and potential future applications of AAR and FLIP and highlights the unanswered questions relevant to these new technologies.

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“…Few reports to date, however, have assessed the functional cooperation between the IAS and EAS, as the two sphincters were usually examined separately. Another reason of few interests in the distal IAS-EAS complex was found in a fact that, with an aid of the levator ani muscle, a closing pressure is highest in the proximal anal canal, not in the distal [5,10,33].…”

Section: Discussionmentioning

confidence: 99%

“…However, recently, another term "longitudinal anal muscle" has been used in the pelvic floor anatomy [16,21,28,30]. Despite recent advances in imaging technology [5,10,22,33], few studies have evaluated site-dependent differences in the topographical relationship between the internal and external anal sphincters (IAS, EAS). Endoanal ultrasound evaluation of 12 men and 14 women showed that: (1) the anterior IAS is shorter than the posterior and lateral IAS; and (2) the distance from the lateral EAS to the pubis is significantly longer than the distance from the posterior EAS to the pubis [29].…”

Section: Introductionmentioning

confidence: 99%

A missing distal complex of the external and internal anal sphincters: a macroscopic and histologic study using Japanese and German elderly cadavers

Ishiyama¹,

Kim

Chai

et al. 2020

Surg Radiol Anat

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The lower margin of the internal anal sphincter (IAS) is considered to lie on a J-shaped, subcutaneous part (SCP) of the external anal sphincter (EAS). The lower IAS is united with the J-shaped SCP to form a smooth-striated muscle complex. In the first part of this study, we ensured the presence of the J-shaped EAS in the lateral wall of the anal canal from 12 near-term fetuses. Second, in the lateral anal wall, the examination of the longitudinal section from 20 male and 24 female Japanese cadavers (72-95 years-old) demonstrated that the J-shaped EAS was lost in 15 (34%) due to the very small SCP. Third, we demonstrated that the J-shaped EAS was restricted in the latera anal wall using longitudinal histological sections of the anal canal from 11 male Japanese cadavers (75-89 years-old). Therefore, a site-dependent difference in the IAS-EAS configuration was evident. Finally, we compared a frequency of the lost J-shape between human populations using 10 mm-thick frontal slices from 36 Japanese and 28 German cadavers. The two groups of cadavers were compatible in age (a 0.2-years' difference in males). The macroscopic observations revealed that the J-shaped EAS was absent from 13 (36%) Japanese and six (20%) German specimens, suggesting that the SCP degeneration occurred more frequent in elderly Japanese than elderly German individuals (p < 0.05). The distal IAS-EAS complex seemed to push residual feces out of the anal canal at a transient phase from evacuation to closure. The absence might be the first sigh of anal dysfunction.

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Anatomy and mechanical properties of the anal sphincter muscles in healthy senior volunteers

Cited by 4 publications

References 20 publications

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

Current and future perspectives on the utility of provocative tests of anal sphincter function: A state‐of‐the‐art summary

A missing distal complex of the external and internal anal sphincters: a macroscopic and histologic study using Japanese and German elderly cadavers

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Anatomy and mechanical properties of the anal sphincter muscles in healthy senior volunteers

Cited by 4 publications

References 20 publications

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP®) in the gastrointestinal tract: A systematic review

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP®) in the gastrointestinal tract: A systematic review

Current and future perspectives on the utility of provocative tests of anal sphincter function: A state‐of‐the‐art summary

A missing distal complex of the external and internal anal sphincters: a macroscopic and histologic study using Japanese and German elderly cadavers

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Product

Resources

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The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review