Anal sphincter function as assessed by 3D high definition anorectal manometry.
PURPOSE
High resolution anorectal manometry has been developed over the past years, as well as 3D high definition manometry (HDARM). However, the clinical impact of the results obtained with these new technologies remains to be determined. We thus analyzed various HDARM parameters of anal sphincter function and tested their capacity to discriminate between patients with constipation and those with fecal incontinence.


METHODS
One hundred and fourteen consecutive patients underwent the same HDARM protocol (Medtronic), including 2 short duration voluntary anal contractions (5seconds) and 1 sustained (as long as possible) contraction. Various parameters evaluating the anal sphincter function were measured, based on automatic software analysis and Smartmouse™ item of the software; resting anal pressures, anal pressures and incremental pressures during voluntary squeeze and cough anal reflex. The ability of these parameters to discriminate between patients with fecal incontinence and chronic constipation was assessed using areas under the curves of ROC curves.


RESULTS
All parameters were highly correlated. The most discriminant variable was found to be the mean anal pressure during sustained squeeze. The 3D lambda aspect of the anal sphincter during voluntary contraction was as frequently absent in both groups of patients (13% in patients with chronic constipation, versus 23% in those with fecal incontinence, P=0.18). There was a significant correlation between the fecal incontinence Wexner score and the voluntary anal contraction variables.


CONCLUSIONS
Several parameters to assess the quality of voluntary anal contraction have been proposed. We observed with HDARM that the most discriminant parameter was the mean anal pressure during sustained squeeze. This may help to standardize and simplify HDARM protocols.
['Mion|François|F|', 'Garros|Aurélien|A|', 'Subtil|Fabien|F|', 'Damon|Henri|H|', 'Roman|Sabine|S|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001003:Anal Canal D003248:Constipation D003672:Defecation D005242:Fecal Incontinence D005260:Female D006801:Humans D008297:Male D008365:Manometry D008875:Middle Aged D011312:Pressure D012984:Software D055815:Young Adult
Anorectal manometry Constipation Fecal incontinence Human Sensitivity and specificity