Dataset Information

Review of the indications, methods, and clinical utility of anorectal manometry and the rectal balloon expulsion test.

ABSTRACT:

Background

Anorectal manometry (ARM) comprehensively assesses anorectal sensorimotor functions.

Purpose

This review examines the indications, techniques, interpretation, strengths, and weaknesses of high-resolution ARM (HR-ARM), 3-dimensional high-resolution anorectal manometry (3D-HR-ARM), and portable ARM, and other assessments (i.e., rectal sensation and rectal balloon expulsion test) that are performed alongside manometry. It is based on a literature search of articles related to ARM in adults. HR-ARM and 3D-HR-ARM are useful for diagnosing defecatory disorders (DD), to identify anorectal sensorimotor dysfunction and guide management in patients with fecal incontinence (FI), constipation, megacolon, and megarectum; and to screen for anorectal structural (e.g., rectal intussusception) abnormalities. The rectal balloon expulsion test is a useful, low-cost, radiation-free, outpatient assessment tool for impaired evacuation that is performed and interpreted in conjunction with ARM. The anorectal function tests should be interpreted with reference to age- and sex-matched normal values, clinical features, and results of other tests. A larger database of technique-specific normal values and newer paradigms of analyzing anorectal pressure profiles will increase the precision and diagnostic utility of HR-ARM for identifying abnormal mechanisms of defecation and continence.

SUBMITTER: Bharucha AE

PROVIDER: S-EPMC9418387 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

Review of the indications, methods, and clinical utility of anorectal manometry and the rectal balloon expulsion test.

Bharucha Adil E AE Basilisco Guido G Malcolm Allison A Lee Tae Hee TH Hoy Matthew B MB Scott S Mark SM Rao Satish S C SSC

Neurogastroenterology and motility 20220227 9

<h4>Background</h4>Anorectal manometry (ARM) comprehensively assesses anorectal sensorimotor functions.<h4>Purpose</h4>This review examines the indications, techniques, interpretation, strengths, and weaknesses of high-resolution ARM (HR-ARM), 3-dimensional high-resolution anorectal manometry (3D-HR-ARM), and portable ARM, and other assessments (i.e., rectal sensation and rectal balloon expulsion test) that are performed alongside manometry. It is based on a literature search of articles related ...[more]

PMID: 35220645

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Project description:BackgroundAnorectal manometry (ARM) is primarily used to assess anorectal sensorimotor function. ARM provides comprehensive information about the anal sphincter and rectal sensation in patients with constipation or fecal incontinence. Generally, ARM can be applied to both adults and children. This study is the first to report a case of post-rectal resection ARM with constipation complicating rectal bleeding and perforation in a patient with no history of rectal cancer, aiming to provide guidelines for the treatment of patients who undergo ARM after rectal surgery.Case descriptionA 58-year-old female patient with previous history of "hypertension and cerebral infarction" underwent "proctocolectomy" for "rectal prolapse" 11+ months ago and recovered well after the operation, but developed constipation. The patient was admitted to our hospital for anorectal manometry (ARM) for "constipation for 11+ months". 2+ hours after the examination, the patient developed blood in the stool and was hospitalized in the Department of Anorectal Surgery of our hospital. The anorectal manometry was performed 2+ hours after the patient developed blood in the stool. The patient was discharged after 30 days of hospitalization without any complications. During treatment, the patient suffered from rectal rupture and perforation. Following timely and aggressive surgery, the patient recovered and was discharged without any complications.ConclusionsARM with balloon, as a method for detecting anorectal function, should only be performed cautiously after rectal surgery, especially among patients with comorbidities. If patients suffer from anorectal bleeding and perforation during ARM, prompt and aggressive surgical intervention is necessary. At present, there is little literature on ARM teaching courses. To improve the operation level of ARM and reduce the incidence of complications, we should extend understandings of ARM, develop a systematic management plan, and continuously summarize ARM-related experiences.

Project description:Abnormal visceral perception and motor function are often observed in patients with fecal incontinence, evacuation disorders and irritable bowel syndrome. The international anorectal physiology working group has proposed a standardization for anorectal function assessment, where rectal sensitivity testing is performed using an elastic balloon attached to a high-resolution anorectal manometry (HRAM) catheter. Rectal compliance, another component of rectal function evaluation, is a pressure-volume relationship that refers to the rectum's ability to stretch and expand as it receives and holds fecal matter. There are no data available regarding the possibility of compliance testing using HRAM, although this is theoretically possible by correcting for the elastic balloon's intrinsic properties. The gold standard for measurement of visceral sensitivity and compliance is the rectal barostat, according to the procedure described by the European COST action GENIEUR group. Data on the agreement between the two different procedures are scarce. Hence, we performed a comparative study of the HRAM and barostat investigations in 26 healthy individuals. We hypothesized that by inflating the balloon before the examination, rectal compliance can be measured with HRAM investigations, and we examined correlations and levels of agreement between the methods. Our results demonstrate that assessing rectal compliance with HRAM is technically possible; however, a strong correlation with the rectal barostat was only observed at the maximum tolerable volume (Spearman's rho = 0.7, p = 0.02). We only found moderate correlations (Spearman's rho = 0.562, p = 0.019) for compliance according to the barostat methodology and for rectal sensibility testing (Spearman's rho = 0.57, p = 0.03 for maximum tolerable volume). Bland-Altman plots showed poor levels of agreement between the methods. We conclude that HRAM and the rectal barostat cannot be used interchangeably for compliance or sensitivity assessments. We suggest the development of a non-elastic balloon with a fixed size and shape to assess rectal sensory function and compliance in HRAM testing.

Project description:Despite surgical correction, children with anorectal malformations may experience long-term bowel dysfunction, including fecal incontinence and/or disorders of evacuation. Anorectal manometry is the most widely used test of anorectal function. Although considerable attention has been devoted to its application in the anorectal malformation cohort, there have been few attempts to consolidate the findings obtained. This systematic review aimed to (1) synthesize and evaluate the existing data regarding anorectal manometry results in children following anorectal malformation repair, and (2) evaluate the manometry protocols utilized, including equipment, assessment approach, and interpretation. We reviewed four databases (Embase, MEDLINE, the Cochrane Library, and PubMed) for relevant articles published between 1 January 1985 and 10 March 2022. Studies reporting post-operative anorectal manometry in children (<18 years) following anorectal malformation repair were evaluated for eligibility. Sixty-three studies were eligible for inclusion. Of the combined total cohort of 2155 patients, anorectal manometry results were reported for 1755 children following repair of anorectal malformations. Reduced resting pressure was consistently identified in children with anorectal malformations, particularly in those with more complex malformation types and/or fecal incontinence. Significant variability was identified in relation to manometry equipment, protocols, and interpretation. Few studies provided adequate cohort medical characteristics to facilitate interpretation of anorectal manometry findings within the context of the broader continence mechanism. This review highlights a widespread lack of standardization in the anorectal manometry procedure used to assess anorectal function in children following anorectal malformation repair. Consequently, interpretation and comparison of findings, both within and between institutions, is exceedingly challenging, if not impossible. Standardized manometry protocols, accompanied by a consistent approach to analysis, including definitions of normality and abnormality, are essential to enhance the comparability and clinical relevance of results.

Dataset Information

Review of the indications, methods, and clinical utility of anorectal manometry and the rectal balloon expulsion test.

Background

Purpose

Publications

Review of the indications, methods, and clinical utility of anorectal manometry and the rectal balloon expulsion test.

Similar Datasets

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