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Suppurative Processes of Anorectal Region: Endoanal Ultrasonographic Assistance

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Ano-Rectal Endosonography and Manometry in Paediatrics
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Abstract

Endoanal ultrasound, using specific ultrasound criteria, H2O2 injection and 3D reconstructions, allows accurately defining the topography of the fistula tract and its relationship with the anal sphincters, detecting secondary extensions and furnishing information regarding the existence of anal sphincter defects before surgery. All this information is critical to reducing the risk of septic recurrence and post-operative faecal incontinence. In expert hands, it also plays an important part in the assessment of complex, Crohn-related and recurrent fistulas.

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References

  1. Goligher J. Fistula-in-ano. In: Goligher J, editor. Surgery of the anus, rectum, and colon. 5th ed. Bailliere Tindall; 1984. p. 178–220.

    Google Scholar 

  2. Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73:219–24.

    CAS  PubMed  Google Scholar 

  3. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63:1–12.

    Article  CAS  PubMed  Google Scholar 

  4. Rosa G, Lolli P, Piccinelli D, et al. Fistula in ano: anatomoclinical aspects, surgical therapy and results in 844 patients. Tech Coloproctol. 2006;10:215–21.

    Article  CAS  PubMed  Google Scholar 

  5. Law PJ, Bartram CI. Anal endosonography: technique and normal anatomy. Gastrointest Radiol. 1989;14:349–53.

    Article  CAS  PubMed  Google Scholar 

  6. Law PJ, Talbot RW, Bartram CI, et al. Anal endosonography in the evaluation of perianal sepsis and fistula in ano. Br J Surg. 1989;76:752–5.

    Article  CAS  PubMed  Google Scholar 

  7. Nuernberg D, Saftoiu A, Barreiros AP, et al. EFSUMB recommendations for gastrointestinal ultrasound part 3: endorectal, endoanal and perineal ultrasound. Ultrasound Int Open. 2019;5:E34–51.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Vogel JD, Johnson EK, Morris AM, et al. Clinical practice guideline for the Management of Anorectal Abscess, fistula-in-Ano, and rectovaginal fistula. Dis Colon Rectum. 2016;59:1117–33.

    Article  PubMed  Google Scholar 

  9. Bartram C, Buchanan G. Imaging anal fistula. Radiol Clin N Am. 2003;41:443–57.

    Article  PubMed  Google Scholar 

  10. Choen S, Burnett S, Bartram CI, et al. Comparison between anal endosonography and digital examination in the evaluation of anal fistulae. Br J Surg. 1991;78:445–7.

    Article  CAS  PubMed  Google Scholar 

  11. Cho DY. Endosonographic criteria for an internal opening of fistula-in-ano. Dis Colon Rectum. 1999;42:515–8.

    Article  CAS  PubMed  Google Scholar 

  12. Santoro GA, DiFalco G. Endoanal ultrasonography in the evaluation of perianal sepsis and fistula-in-ano: introduction. In: Santoro GA, DiFalco G, editors. Benign anorectal diseases: diagnosis with Endoanal and Endorectal ultrasound and new treatment options. New York: Springer; 2006. p. 130–9.

    Chapter  Google Scholar 

  13. Lengyel AJ, Hurst NG, Williams JG. Pre-operative assessment of anal fistulas using endoanal ultrasound. Color Dis. 2002;4:436–40.

    Article  CAS  Google Scholar 

  14. Lindsey I, Humphreys MM, George BD, et al. The role of anal ultrasound in the management of anal fistulas. Color Dis. 2002;4:118–22.

    Article  CAS  Google Scholar 

  15. Santoro GA, Fortling B. The advantages of volume rendering in three-dimensional endosonography of the anorectum. Dis Colon Rectum. 2007;50:359–68.

    Article  PubMed  Google Scholar 

  16. Cheong DM, Nogueras JJ, Wexner SD, et al. Anal endosonography for recurrent anal fistulas: image enhancement with hydrogen peroxide. Dis Colon Rectum. 1993;36:1158–60.

    Article  CAS  PubMed  Google Scholar 

  17. Poen AC, Felt-Bersma RJ, Eijsbouts QA, et al. Hydrogen peroxide enhanced transanal ultrasound in the assessment of fistula-in-ano. Dis Colon Rectum. 1998;41:1147–52.

    Article  CAS  PubMed  Google Scholar 

  18. Ratto C, Gentile E, Merico M, et al. How can the assessment of fistula-in-ano be improved? Dis Colon Rectum. 2000;43:1375–82.

    Article  CAS  PubMed  Google Scholar 

  19. Kruskal JB, Kane RA, Morrin MM. Peroxide-enhanced anal endosonography: technique, image interpretation, and clinical applications. Radiographics. 2001;21:S173–89.

    Article  PubMed  Google Scholar 

  20. Navarro-Luna A, Garcia-Domingo MI, Rius-Macias J, et al. Ultrasound study of anal fistulas with hydrogen peroxide enhancement. Dis Colon Rectum. 2004;47:108–14.

    Article  PubMed  Google Scholar 

  21. Chew SS, Yang JL, Newstead GL, et al. Anal fistula: Levovist-enhanced endoanal ultrasound: a pilot study. Dis Colon Rectum. 2003;46:377–84.

    Article  PubMed  Google Scholar 

  22. Gravante G, Giordano P. The role of three-dimensional endoluminal ultrasound imaging in the evaluation of anorectal diseases: a review. Surg Endosc. 2008;22:1570–8.

    Article  PubMed  Google Scholar 

  23. Buchanan GN, Bartram CI, Williams AB, et al. Value of hydrogen peroxide enhancement of three-dimensional endoanal ultrasound in fistula-in-ano. Dis Colon Rectum. 2005;48:141–7.

    Article  PubMed  Google Scholar 

  24. Garcés-Albir M, García-Botello SA, Esclapez-Valero P, et al. Quantifying the extent of fistulotomy. How much sphincter can we safely divide? A three-dimensional endosonographic study. Int J Colorectal Dis. 2012;27:1109–16.

    Article  PubMed  Google Scholar 

  25. Brillantino A, Iacobellis F, SarnoG D, et al. Role of tri-dimensional endoanal ultrasound (3D-EAUS) in the preoperative assessment of perianal sepsis. Int J Color Dis. 2015;30:535–42.

    Article  Google Scholar 

  26. Garcés-Albir M, García-Botello SA, Espi A, et al. Three-dimensional endoanal ultrasound for diagnosis of perianal fistulas: reliable and objective technique. World J Gastrointest Surg. 2016;8:513–20.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ratto C, Grillo E, Parello A, et al. Endoanal ultrasound−guided surgery for anal fistula. Endoscopy. 2005;37:722–8.

    Article  CAS  PubMed  Google Scholar 

  28. Kołodziejczak M, Santoro GA, Obcowska A. Three-dimensional endoanal ultrasound is accurate and reproducible in determining type and height of anal fistulas. Color Dis. 2017;19:378–84.

    Article  Google Scholar 

  29. Emile SH, Magdy A, Youssef M, et al. Utility of Endoanal ultrasonography in assessment of primary and recurrent anal fistulas and for detection of associated anal sphincter defects. J Gastrointest Surg. 2017;21:1879–87.

    Article  PubMed  Google Scholar 

  30. Sloots CEJ, Felt-Bersma RJF, Poen AC, et al. Assessment and classification of fistula-in-ano in patients with Crohn’s disease by hydrogen peroxide enhanced transanal ultrasound. Int J Color Dis. 2001;16:292–7.

    Article  CAS  Google Scholar 

  31. Zawadzki A, Starck M, Bohe M, et al. A unique 3D endoanal ultrasound feature of perianal Crohn’s fistula: the ‘Crohn ultrasound fistula sign’. Color Dis. 2012;14:e608–11.

    Article  CAS  Google Scholar 

  32. Blom J, Nyström PO, Gunnarsson U, et al. Endoanal ultrasonography may distinguish Crohn’s anal fistulae from cryptoglandular fistulae in patients with Crohn’s disease: a cross-sectional study. Tech Coloproctol. 2011;15:327–30.

    Article  CAS  PubMed  Google Scholar 

  33. Zbar AP, Horesh N, Bucholtz V, et al. Are there specific endosonographic features in Crohn’s patients with perianal fistulae? J Crohns Colitis. 2013;7:490–6.

    Article  PubMed  Google Scholar 

  34. Luglio G, Giglio MC, Rispo A, et al. Diagnostic accuracy of 3-dimensional endoanal ultrasound in identifying perianal Crohn’s fistulas. Dis Colon Rectum. 2018;61:931–7.

    Article  PubMed  Google Scholar 

  35. Lahat A, Assulin Y, Beer-Gabel M, et al. Endoscopic ultrasound for perianal Crohnʼs disease: disease and fistula characteristics, and impact on therapy. J Crohns Colitis. 2012;6:311–6.

    Article  PubMed  Google Scholar 

  36. Wiese DM, Beaulieu D, Slaughter JC, et al. Use of endoscopic ultrasound to guide adalimumab treatment in perianal Crohn’s disease results in faster fistula healing. Inflamm Bowel Dis. 2015;21:1594–9.

    Article  PubMed  Google Scholar 

  37. Spradlin NM, Wise PE, Herline AJ, et al. A randomized prospective trial of endoscopic ultrasound to guide combination medical and surgical treatment for Crohnʼs perianal fistulas. Am J Gastroenterol. 2008;103:2527–35.

    Article  PubMed  Google Scholar 

  38. Schwartz DA, White CM, Wise PE, Herline AJ. Use of endoscopic ultrasound to guide combination medical and surgical therapy for patients with Crohnʼs perianal fistulas. Inflamm Bowel Dis. 2005;11:727–32.

    Article  PubMed  Google Scholar 

  39. Ardizzone S, Maconi G, Colombo E, et al. Perianal fistulae following infliximab treatment: clinical and endosonographic outcome. Inflamm Bowel Dis. 2004;10:91–6.

    Article  PubMed  Google Scholar 

  40. West RL, Woude van der CJ, Hansen BE, et al. Clinical and endosonographic effect of ciprofloxacin on the treatment of perianal fistulas. Aliment Pharmacol Ther. 2004;20:1329–36.

    Article  CAS  PubMed  Google Scholar 

  41. van Bodegraven AA, Sloots CEJ, Felt-Bersma RJF. Endosonographic evidence of persistence of Crohn’s disease-associated fistulas after infliximab treatment, irrespective of clinical response. Dis Colon Rectum. 2002;45(1):39–45.

    Article  PubMed  Google Scholar 

  42. Guidi L, Ratto C, Semeraro S, et al. Combined therapy with infliximab and seton drainage for perianal fistulizing Crohn’s disease with anal endosonographic monitoring: a single-Centre experience. Tech Coloproctol. 2008;12:111–7.

    Article  CAS  PubMed  Google Scholar 

  43. Bemelman WA, Warusavitarne J, Sampietro GM, et al. ECCO-ESCP consensus on surgery for Crohn's disease. J Crohns Colitis. 2018;12:1–16.

    PubMed  Google Scholar 

  44. Gecse KB, Bemelman W, Kamm MA, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut. 2014;63:1381–92.

    Article  PubMed  Google Scholar 

  45. Kim Y, Park YJ. Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H (2)O(2) enhancement. World J Gastroenterol. 2009;15:4810–5.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Alabiso ME, Iasiello F, Pellino G, et al. 3D-EAUS and MRI in the activity of anal fistulas in Crohnʼs disease. Gastroenterol Res Pract. 2016;2016:1895694.

    Article  PubMed  Google Scholar 

  47. Gustafsson UM, Kahvecioglu B, Aström G, et al. Endoanal ultrasound or magnetic resonance imaging for preoperative assessment of anal fistula: a comparative study. Color Dis. 2001;3:189–97.

    Article  CAS  Google Scholar 

  48. West RL, Zimmerman DDE, 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. 2003;46:1407–15.

    Article  CAS  PubMed  Google Scholar 

  49. Siddiqui MR, Ashrafian H, Tozer P, et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012;55:576–85.

    Article  PubMed  Google Scholar 

  50. Sudoł-Szopinska I, Kucharczyk A, Kołodziejczak M, et al. Endosonography and magnetic resonance imaging in the diagnosis of high anal fistulae—a comparison. J Ultrason. 2014;4(14):142–51.

    Google Scholar 

  51. Schwartz DA, Wiersema MJ, Dudiak KM, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology. 2001;121:1064–72.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Dajana Cuicchi .

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Cuicchi, D., Poggioli, G. (2022). Suppurative Processes of Anorectal Region: Endoanal Ultrasonographic Assistance. In: Lima, M., Ruggeri, G. (eds) Ano-Rectal Endosonography and Manometry in Paediatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-97668-2_9

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  • DOI: https://doi.org/10.1007/978-3-030-97668-2_9

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-97668-2

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