Prospective Multicenter Trial Comparing Echodefecography With Defecography in the Assessment of Anorectal Dysfunction in Patients With Obstructed Defecation
BACKGROUND:Defecography is the gold standard for assessing functional anorectal disorders but is limited by the need for a specific radiologic environment, exposure of patients to radiation, and inability to show all anatomic structures involved in defecation. Echodefecography is a 3-dimensional dyn...
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| Published in: | Diseases of the colon & rectum Vol. 54; no. 6; pp. 686 - 692 |
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| Main Authors: | , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Hagerstown, MDc
The ASCRS
01-06-2011
Lippincott Williams & Wilkins |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | BACKGROUND:Defecography is the gold standard for assessing functional anorectal disorders but is limited by the need for a specific radiologic environment, exposure of patients to radiation, and inability to show all anatomic structures involved in defecation. Echodefecography is a 3-dimensional dynamic ultrasound technique developed to overcome these limitations.
OBJECTIVE:This study was designed to validate the effectiveness of echodefecography compared with defecography in the assessment of anorectal dysfunctions related to obstructed defecation.
DESIGN:Multicenter, prospective observational study.
PATIENTS:Women with symptoms of obstructed defecation.
SETTING:Six centers for colorectal surgery (3 in Brazil, 1 in Texas, 1 in Florida, and 1 in Venezuela).
INTERVENTIONS:Defecography was performed after inserting 150 mL of barium paste in the rectum. Echodefecography was performed with a 2050 endoprobe through 3 automatic scans.
MAIN OUTCOME MEASURES:The κ statistic was used to assess agreement between echodefecography and defecography in the evaluation of rectocele, intussusception, anismus, and grade III enterocele.
RESULTS:Eighty-six women were evaluatedmedian Wexner constipation score, 13.4 (range, 6–23); median age, 53.4 (range, 26–77) years. Rectocele was identified with substantial agreement between the 2 methods (defecography, 80 patients; echodefecography, 76 patients; κ = 0.61; 95% CI = 0.48–0.73). The 2 techniques demonstrated identical findings in 6 patients without rectocele, and in 9 patients with grade I, 29 with grade II, and 19 patients with grade III rectoceles. Defecography identified rectal intussusception in 42 patients, with echodefecography identifying 37 of these cases, plus 4 additional cases, yielding substantial agreement (κ = 0.79; 95% CI = 0.57–1.0). Intussusception was associated with rectocele in 28 patients for both methods (κ = 0.62; 95% CI = 0.41–0.83). There was substantial agreement for anismus (κ = 0.61; 95% CI = 0.40–0.81) and for rectocele combined with anismus (κ = 0.61; 95% CI = 0.40–0.82). Agreement for grade III enterocele was classified as almost perfect (κ = 0.87; 95% CI = 0.66–1.0).
LIMITATIONS:Echodefecography had limited use in identification of grade I and II enteroceles because of the type of probe used.
CONCLUSIONS:Echodefecography may be used to assess patients with obstructed defecation, as it is able to detect the same anorectal dysfunctions found by defecography. It is minimally invasive and well tolerated, avoids exposure to radiation, and clearly demonstrates all the anatomic structures involved in defecation. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0012-3706 1530-0358 |
| DOI: | 10.1007/DCR.0b013e3182113ac7 |