Abstract
Tests for evaluating incontinence include endoanal ultrasound (EUS) and anorectal manometry. We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correctable sphincter defects leading to an improvement in clinical outcome in these patients. The purpose of this study was to compare these 2 techniques to determine which is more predictive of outcome for fecal incontinence. Thirty-five unselected patients with fecal incontinence were prospectively studied with EUS and anorectal manometry to evaluate the internal anal sphincter (IAS) and external anal sphincter (EAS). EUS was performed with Olympus GFUM20 echoendoscope and a hypoechoic defect in the EAS or IAS was considered a positive test. Anorectal manometry was performed with a standard water-perfused catheter system. A peak voluntary squeeze pressure of < 60 mm Hg in women and 120 mm Hg in men was considered a positive test. All patients were administered the Cleveland Clinic Continence Grading Scale at baseline and at follow-up. Improvement in fecal control was defined as a 25% or greater decrease in continence score. EUS versus manometry were compared with subsequent surgical treatment and outcome. P-values were calculated using Fisher's exact test. Patients (n = 32; 31 females) were followed for a mean 25 months (range 13–46). Sixteen patients had improved symptoms (50%). There was no correlation between EUS or anorectal manometry sphincter findings and outcome. Seven of 14 (50%) patients who subsequently underwent surgery versus 9 of 18 (50%) without surgery improved (P = .578). In long-term follow-up, approximately half of patients improve regardless of the results of EUS or anorectal manometry, or whether surgery is performed.
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References
Nelson RL: Epidemiology of fecal incontinence. Gastroenterology 126(Suppl 1):S3–7, 2004
Sultan AH, Stanton SL: Occult obstetric trauma and anal incontinence. Eur J Gastroenterol Hepatol 9:423–427, 1997
Rao SC: Pathophysiology of adult fecal incontinence. Gastroenterology 126(Suppl 1):S14–22, 2004
Law PJ, Kamm MA, Bartram CI: Anal endosonography in the investigation of faecal incontinence. Br J Surg 78:312–314, 1991
Rieger NA, Sweeney JL, Hoffmann DC, Young JF, Hunger A: Investigation of fecal incontinence with endoanal ultrasound. Dis Colon Rectum 39:860–864, 1996
Sentovich SM, Blatchford GJ, Rivela LJ, Lin K, Thorson AG, Christensen MA: Diagnosing anal sphincter injury with transanal ultrasound and manometry. Dis Colon Rectum 40:1430–1434, 1997
Schafer R, Heyer T, Gantke B, et al.: Anal endosonography and manometry: comparison in patients with defecation problems. Dis Colon Rectum 40:293–297, 1997
Romano G, Rotondano G, Esposito P, Pellecchia L, Novi A: External anal sphincter defects: correlation between pre-operative anal endosonography and intraoperative findings. Br J Radiol 69:6–9, 1996
Bharucha AE: Outcome measures for fecal incontinence. Gastroenterology 126(Suppl 1):S90–98, 2004
Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI: Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg 81:463–465, 1994
Felt-Bersma RJ, Klinkenberg-Knoll EC, Meuwissen SGM: Anorectal function investigations in incontinent and continent patients. Dis Colon Rectum 33:479–486, 1990
Motulsky H: Intuitive Biostatistics. New York, Oxford University Press, 1995
Jorge JMN, Wexner SD: Etiology and management fecal incontinence. Dis Colon Rectum 36:77–97, 1993
Meyenberger C, Bertschinger P, Zala GF, Buchmann P: Anal sphincter defects in fecal incontinence: correlation between endosonography and surgery. Endoscopy 28:217–224, 1996
Osterberg A, Graf W, Karlbom U, Pahlman L: Evaluation of a questionnaire in the assessment of patients with faecal incontinence and constipation. Scand J Gastroenterol 31:575–580, 1996
Keating JP, Stewart PJ, Eyers AA, Warner D, Bokey EL: Are special investigations of value in the management of patients with fecal incontinence? Dis Colon Rectum 40:896–901, 1997
Sagar PM, Pemberton JH: The assessment and treatment of anorectal incontinence (review). Adv Surg 30:1–20, 1996
Madoff RD: Surgical treatment options for fecal incontinence. Gastroenterology 126(Suppl 1):S48–54, 2004
Karoui S, Leroi AM, Koning E, Menard JF, Michot F, Denis P: Results of sphincteroplasty in 86 patients with anal incontinence. Dis Colon Rectum 43:813–820, 2000
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Supported in part by a Glaxo-Wellcome Institute for Digestive Health Award.
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Hill, K., Fanning, S., Fennerty, M.B. et al. Endoanal Ultrasound Compared to Anorectal Manometry for the Evaluation of Fecal Incontinence: A Study of the Effect These Tests Have on Clinical Outcome. Dig Dis Sci 51, 235–240 (2006). https://doi.org/10.1007/s10620-006-3116-0
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DOI: https://doi.org/10.1007/s10620-006-3116-0