Can three‐dimensional high‐resolution anorectal manometry detect anal sphincter defects in patients with faecal incontinence?

Abstract

With a negative predictive value of 92%, 3D HRAM may be a useful screening method for ruling out a sphincter defect in patients with FI, thereby avoiding both EAUS and manometry in selected patients.

Response to ‘Ultrasound anal sphincter defects and 3D anal pressure defects’

“…There are significant similarities between our study [1] and that of Mion et al [2] in terms of the anal pressure profile of patients with fecal incontinence. We believe that the differences in the results of our study compared with those of their study are caused by differences in methodology.…”

Ultrasound anal sphincter defects and 3D anal pressure defects

“…Second, we used slightly different metrics for the diagnosis of pressure defect, to take into account the physiological asymmetry of pressures within the anal canal. This could explain why the prevalence of pressure defects was lower in our series (25%) than in the Rezaie study (36%) . Finally, both series had a relatively small number of observations, which clearly limited their statistical value.…”

“…Our results were different from those of Rezaie et al . , with an excellent positive predictive value (the nine patients with a pressure defect had an EAUS defect, positive predictive value 100%), while the negative predictive value was only 44% (among the 27 patients without pressure defect, 15 had an EAUS defect). Comparing the manometric results in patients with and without EAUS anal sphincter defects, anal resting and squeezing pressures were significantly lower in patients with anal sphincter defects [56 (SD 4) vs 83 (SD 6) mmHg, P = 0.001, and 61 (SD 7) vs 94 (SD 9), P = 0.008, respectively].…”

“…We read with interest the paper by Rezaie et al . on the use of 3D high definition anorectal manometry (3DARM) to detect anal sphincter defects in patients with faecal incontinence . In their series of 39 patients, they described a new metrics to define anal pressure defect (a defect of at least 18° of the 25 mmHg isobaric contour on anal resting pressures) and then compared the results of pressure defects determined by 3DARM and 3D anal ultrasound results.…”

High-Resolution Anorectal Manometry - New Insights in the Diagnostic Assessment of Functional Anorectal Disorders

“…However, normative data in health and disease, as well as validation of the functional impact of pressure defects seen on 3D ARM are still lacking. Therefore, pressure defects seen on 3D-ARM should be verified by further imaging such as endoanal ultrasound [29,30].…”