Skip to main content

Advertisement

Log in

Prospective Comparison of Hydrogen Peroxide–Enhanced Three-Dimensional Endoanal Ultrasonography and Endoanal Magnetic Resonance Imaging of Perianal Fistulas

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: This study was conducted to determine agreement between hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging in the preoperative assessment of perianal fistulas and to compare these results with the surgical findings. METHODS: Twenty-one patients (aged 26–71 years) with clinical symptoms of a cryptoglandular perianal fistula and a visible external opening underwent preoperative hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography, endoanal magnetic resonance imaging, and surgical exploration. The results were assessed separately by experienced observers blinded as to each other’s findings. Each fistula was described with notice of the following characteristics: classification of the primary fistula tract according to Parks (intersphincteric, transsphincteric, extrasphincteric, or suprasphincteric), horseshoe, or not classified; presence of secondary tracts (circular or linear); and location of an internal opening. RESULTS: The median time between hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging was 66 (interquartile range, 21–160) days; the median time between the last study (hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography or endoanal magnetic resonance imaging) and surgery was 154 (interquartile range, 95–189) days. Agreement for the classification of the primary fistula tract was 81 percent for hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography and surgery, 90 percent for endoanal magnetic resonance imaging and surgery, and 90 percent for hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging. For secondary tracts, agreement was 67 percent for hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography and surgery, 57 percent for endoanal magnetic resonance imaging and surgery, and 71 percent for hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging in case of circular tracts and 76 percent, 81 percent, and 71 percent, respectively, in case of linear tracts. Agreement for the location of an internal opening was 86 percent for hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography and surgery, 86 percent for endoanal magnetic resonance imaging and surgery, and 90 percent for hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging. CONCLUSIONS: For evaluation of perianal fistulas, hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging have good agreement, especially for classification of the primary fistula tract and the location of an internal opening. These results also show good agreement compared with surgical findings. Therefore, hydrogen peroxide–enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging can both be used as reliable methods for preoperative evaluation of perianal fistulas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. DM Cheong JJ Nogueras SD Wexner DG Jagelman (1993) ArticleTitleAnal endosonography for recurrent anal fistulas Dis Colon Rectum 36 1158–1160

    Google Scholar 

  2. AC Poen RJ Felt-Bersma QA Eijsbouts MA Cuesta SG Meuwissen (1998) ArticleTitleHydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano Dis Colon Rectum 41 1147–1152

    Google Scholar 

  3. C Ratto E Gentile M Merico et al. (2000) ArticleTitleHow can the assessment of fistula-in-ano be improved? Dis Colon Rectum 43 1375–1382

    Google Scholar 

  4. CE Sloots RJ Felt-Bersma AC Poen MA Cuesta (2001) ArticleTitleAssessment and classification of never operated and recurrent cryptoglandular fistulas-in-ano using hydrogen peroxide enhanced transanal ultrasound Colorectal Dis 3 422–426

    Google Scholar 

  5. I Sudol-Szopinska W Jakubowski M Szczepkowski (2002) ArticleTitleContrast-enhanced endosonography for the diagnosis of anal and anovaginal fistulas J Clin Ultrasound 30 145–150

    Google Scholar 

  6. RL West CE Sloots RJ Felt-Bersma EJ Kuipers (2002) ArticleTitle3D transanal ultrasonography Gastroenterology 122 331–150

    Google Scholar 

  7. P Orsoni M Barthet F Portier M Panuel A Desjeux JC Grimaud (1999) ArticleTitleProspective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn’s disease Br J Surg 86 360–364

    Google Scholar 

  8. UM Gustafsson B Kahvecioglu G Aström H Ahlström W Graf (2001) ArticleTitleEndoanal ultrasound or magnetic resonance imaging for preoperative assessment of anal fistula Colorectal Dis 3 189–197

    Google Scholar 

  9. PJ Lunniss PG Barker AH Sultan et al. (1994) ArticleTitleMagnetic resonance imaging of fistula-in-ano Dis Colon Rectum 37 708–718

    Google Scholar 

  10. SM Hussain J Stoker WR Schouten WC Hop JS Laméris (1996) ArticleTitleFistula in ano Radiology 200 475–481

    Google Scholar 

  11. DA Schwartz MJ Wiersema KM Dudiak et al. (2001) ArticleTitleA comparison of endoscopic ultrasound, magnetic resonance imaging and exam under anesthesia for evaluation of Crohn’s perianal fistulas Gastroenterology 121 1064–1072

    Google Scholar 

  12. AG Parks PH Gordon JD Hardcastle (1976) ArticleTitleA classification of fistula-in-ano Br J Surg 63 1–12

    Google Scholar 

  13. WR Schouten DD Zimmerman JW Briel (1999) ArticleTitleTransanal advancement flap repair of transsphincteric fistulas Dis Colon Rectum 42 1419–1423

    Google Scholar 

  14. DD Zimmerman JB Delemarre MP Gosselink WC Hop JW Briel WR Schouten (2003) ArticleTitleSmoking affects the outcome of transanal advancement flap repair of transsphincteric fistulas Br J Surg 90 351–354

    Google Scholar 

  15. CE Sloots RJ Felt-Bersma AC Poen MA Cuesta SG Meuwissen (2001) ArticleTitleAssessment and classification of fistula-in-ano in patients with Crohn’s disease by hydrogen peroxide enhanced transanal ultrasound Int J Colorectal Dis 16 292–297

    Google Scholar 

  16. JA Spencer K Chapple D Wilson AC Windsor NS Ambrose (1998) ArticleTitleOutcome after surgery for perianal fistula AJR Am J Roentgenol 171 403–406

    Google Scholar 

  17. G Ozuner TL Hull J Cartmill VW Fazio (1996) ArticleTitleLong-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas Dis Colon Rectum 39 10–14

    Google Scholar 

  18. SM Hussain J Stoker JS Lameris (1995) ArticleTitleAnal sphincter complex Radiology 197 671–677

    Google Scholar 

  19. NM deSouza AS Hall R Puni DJ Gilderdale IR Young WA Kmiot (1996) ArticleTitleHigh resolution magnetic resonance imaging of the anal sphincter using a dedicated endoanal coil Dis Colon Rectum 39 926–934

    Google Scholar 

  20. J Stoker SM Hussain D van Kempen AJ Elevelt JS Laméris (1996) ArticleTitleEndoanal coil in MR imaging of anal fistulas AJR Am J Roentgenol 166 360–362

    Google Scholar 

  21. S Halligan CI Bartram (1998) ArticleTitleMR imaging of fistula in ano AJR Am J Roentgenol 171 407–412

    Google Scholar 

  22. NM deSouza DJ Gilderdale GA Coutts R Puni RE Steiner (1998) ArticleTitleMRI of fistula-in-ano J Comput Assist Tomogr 22 357–363

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

About this article

Cite this article

West, R.L., Zimmerman, D.D., Dwarkasing, S. et al. Prospective Comparison of Hydrogen Peroxide–Enhanced Three-Dimensional Endoanal Ultrasonography and Endoanal Magnetic Resonance Imaging of Perianal Fistulas. Dis Colon Rectum 46, 1407–1415 (2003). https://doi.org/10.1007/s10350-004-6758-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-6758-z

Keywords

Navigation