Comparison of Anorectal Function as Measured with High-Resolution and High-Definition Anorectal Manometry

Abstract

<b><i>Introduction:</i></b> Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in the rectum and anal canal. Absolute pressure values might depend on the catheter used. <b><i>Objective:</i></b> Our aim was to compare the results obtained by different anorectal catheters in children with functional anorectal disorders. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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; <i>p</i> = 0.000). Intrarectal pressure measured by 3D and 2D catheters was similar (35 vs. 39 mm Hg, respectively; <i>p</i> = 0.761), but the percent of anal relaxation appeared to be higher for the 3D than for the 2D probe (12 vs. 5%, respectively; <i>p</i> = 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 (<i>p</i> = 0.044). Cohen’s kappa showed only fair agreement between the catheters (κ = 0.40) in diagnosis of DD. <b><i>Conclusions:</i></b> 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).

Testing in functional constipation—What's new and what works

“…Two recent prospective studies reported a higher anal resting pressure recorded and conflictive RAIR findings when 3D high-resolution ARM (HRARM) is used compared to 2D HRARM consecutively on the same patients. 63 However, Keshtgar et al in another recent study reported no significant difference in values of anal resting pressure and volume threshold to elicit RAIR obtained with conventional water perfusion or 3D high-resolution ARM. 64 ARM guidelines for performance and interpretation were revised and published by the American Neurogastroenterology and Motility Society in conjunction with The North American Society of Paediatric Gastroenterology, Hepatology and Nutrition 65 and recently by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN).…”

“…Some have reported differences in the data obtained with different types of catheters. Two recent prospective studies reported a higher anal resting pressure recorded and conflictive RAIR findings when 3D high‐resolution ARM (HRARM) is used compared to 2D HRARM consecutively on the same patients 63 . However, Keshtgar et al.…”

Pelvic floor muscle exercises alleviate symptoms and improve mental health and rectal function in patients with low anterior resection syndrome

“…High-resolution anorectal manometry (HRAM) was performed for all LARS patients as described in a previous study ( 12 ). In brief, one dose of glycerin enema was administered for bowel preparation 30–60 min before the HRAM examination.…”

Anorectal Manometry in Children

“…Of note, normal values from manometric parameters may differ according to age, with lower values of resting pressure and thresholds for RAIR in neonates compared with older children (Table 1) (49,50). Moreover, recorded pressure values may depend on the specific type of pressure sensor used during the test (water-perfused vs solid-state) (51,52), the diameter of the catheter (greater diameter may produce higher pressure values obtained by solid-state sensors) (53,54), the protocol used by investigator (duration of the recording, eg, resting pressure over 30 or 60 seconds) or even the software used to process the recorded data (maximum, mean, median, or increment) (55). Therefore, it is important to use normal values obtained with the same equipment and adequate protocol.…”