Liverpool Ultrasound Pictorial Chart: the development of a new method of documenting anal sphincter injury diagnosed by endoanal ultrasound

Abstract

Objective To develop and validate a pictorial chart that documents ultrasound examination of the anal sphincter.Design A new pictorial chart (Liverpool Ultrasound Pictorial Chart [LUPIC]) depicting the normal anatomy of the anal sphincter was developed.Methods To validate LUPIC, two observers documented the findings of 296 endoanal scans. Reliability was assessed between observers using kappa agreement for presence and position of sphincter defects. To validate the use of LUPIC by different observers, a video of ten endoanal ultrasound scans was reviewed by our local expert (gold standard). Seven clinicians underwent test-retest analysis. Kappa agreement was calculated to assess intra-observer and gold standard versus observer agreement for the overall presence of sphincter defects and compared with the gold standard. Complete agreement for the position and level of sphincter defects was assessed for the five abnormal scans.Main outcome measures Excellent agreement between the two observers was found for the presence (kappa 0.99), position and level of external anal sphincter defects documented using LUPIC. The intra-observer and gold standard versus observer kappa values of experienced clinicians (A-E) showed good agreement for the overall presence of sphincter defects. Complete agreement for the position and level of sphincter defects was found in 23 of 35 (66%) observations.Conclusions LUPIC is designed and validated method of documenting anal sphincter injury diagnosed by endoanal ultrasound. Standardisation of endoanal ultrasound findings by using LUPIC may help correlate the degree of damage with patient symptoms.

Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives

“…EAUS is an accurate, highly sensitive, and safe way of assessing the perineum for OASIS, with none or minimal discomfort for the mother (depending on the size of the probe chosen for the exam) [ 37 , 38 , 39 ].…”

“…Though its role has not been clearly determined yet, EAUS can be used in the early follow-up after anal sphincter repair for OASIS to identify patients at higher risk of long-term complications who may benefit from early referral to specialist centres [ 38 , 40 ].…”

Follow up of women after obstetric anal sphincter injuries (OASI)—What is the role of anorectal testing?

“…EAUS was performed using the BK medical Flex focus 500 ultrasound 1202. Three dimensional images of the sphincter complex were studied across three levels of “high,” “mid,” and “low” as per the Liverpool Ultrasound Pictorial chart 15 . Defects in the muscles of the EAS or IAS were identified as those exceeding 1 h (>30 degrees) 16 on a clock face.…”

Follow up of women after Obstetric Anal Sphincter Injuries (OASI)- what is the role of anorectal studies? An observational study.

“…EAUS was performed using the BK medical Flex focus 500 ultrasound 1202. Three dimensional images of the sphincter complex were studied across three levels of 'high', 'mid' and 'low' as per the Liverpool Ultrasound Pictorial chart (LUPIC) [15]. Defects in the muscles of the EAS or IAS were identified as those exceeding 1 hour (>30 degrees) [16] on a clock face.…”