Feuerhak, Kelly

AbstractBackgroundWhile widely used in clinical practice, the reproducibility of high‐definition anorectal manometry (HD‐ARM) remains unclear. We evaluated the intra‐individual reproducibility of HD‐ARM and compared pressures measured with HD‐ARM and high‐resolution anorectal manometry (HR‐ARM).MethodsThirty‐six women with fecal incontinence had an initial HD‐ARM (HD‐ARM1); on the same day, after randomization, 21 had a second (HD‐ARM2). Sixteen women had a third (HD‐ARM3) 4 weeks later. Twenty‐five had also been evaluated by HR‐ARM previously. Rectoanal pressures were assessed at rest, during squeeze and simulated evacuation. Concordance among pressures was assessed with Lin's concordance correlation coefficient (CCC).Key ResultsAnal resting and squeeze pressures measured with HD‐ARM were reproducible on the same and different days; for average resting pressures of HD‐ARM1 vs HD‐ARM2, CCC = 0.73 (95% confidence interval [CI]: 0.53–0.94), and for HD‐ARM1 vs HD‐ARM3, CCC = 0.60 (95% CI: 0.28–0.93). For maximum squeeze pressures of HD‐ARM1 vs HD‐ARM2, CCC = 0.86 (95% CI: 0.75–0.97), and for HD‐ARM1 vs HD‐ARM3, CCC = 0.56 (95% CI: 0.21–0.91). The rectoanal gradient during evacuation was significantly concordant between HD‐ARM1 and HD‐ARM2 but not HD‐ARM1 and HD‐ARM3. Resting (CCC = 0.38 [95% CI: 0.14–0.62]) and squeeze pressures (CCC = 0.73 [95% CI: 0.57–0.89]) measured with HD‐ARM1 and HR‐ARM were also concordant.Conclusions & InferencesAmong women with fecal incontinence, measurements with HD‐ARM were reproducible on the same (anal resting and squeeze pressures and rectoanal gradient during evacuation) and different days (anal resting and squeeze pressures) and correlated with HR‐ARM measurements. These findings support use of HD‐ARM and HR‐ARM for longitudinal assessments of anal resting and squeeze pressures.

AbstractBackgroundPressure drift (PD), resulting from differences between room and body temperature, reduces the accuracy of pressure measurements with the Manoscan high resolution manometry (HRM) system. Our aims were to assess PD during anorectal HRM.MethodsDefined as the residual pressure measured immediately after the catheter was removed, PD was calculated for each sensor and averaged across all 12 sensors in 454 anorectal consecutive studies recorded with 3 HRM catheters. The relationship between PD and study duration, number of prior uses of a catheter, and peak and average pressure exposure during a study were evaluated. The correction of PD with a software algorithm (thermal compensation) was evaluated in 76 studies where the most distal sensor was outside the body.Key ResultsThe PD varied among sensors and across catheters. The average PD (7.3 ± 0.2 mmHg) was significantly greater for newer catheters, during longer studies, or when sensors were exposed to higher pressures. Together, these factors explained 81% of the variance in overall PD. After thermal compensation, the uncorrected median PD for the most distal sensor was 2.5–5 mmHg over the study duration. Correcting this changed the interpretation (e.g., as abnormal instead of normal) of at least 1 anorectal parameter in eight of 76 studies.Conclusions & InferencesDuring anorectal HRM, PD declines with catheter use and is greater for newer catheters, when sensors are exposed to higher pressures, and for studies of longer duration. While PD is partially corrected with thermal compensation algorithms, the impact on interpretation is modest.

AbstractBackgroundCurrently, anorectal manometry (ARM), which is used to diagnose defecatory disorders and identify anal weakness in fecal incontinence (FI) is generally conducted in specialized laboratories. Our aims were to compare anorectal functions measured with high‐resolution manometry (HRM) and a novel portable manometry device.MethodsAnal pressures at rest, during squeeze, and simulated evacuation, and rectal sensation were evaluated with portable and HRM in 20 healthy women, 19 women with constipation, and 11 with FI. The relationship between anal pressures measured with portable and HRM was assessed by the concordance correlation coefficient (CCC), Bland Altman test, and paired t‐tests.Key ResultsAnal pressures at rest (CCC 0.45; 95% CI: 0.29, 0.58) and during squeeze (CCC 0.60; 95% CI: 0.46, 0.72) measured with portable and HRM were correlated and inversely associated with the risk of FI. During simulated evacuation, the CCC for rectal pressure (0.62; 95% CI: 0.43, 0.76) was greater than that for anal pressure (CCC 0.22; 95% CI: 0.04, 0.39) and the rectoanal gradient (CCC 0.22; 95% CI: 0.02, 0.41). Rectal sensory thresholds for first sensation, the desire to defecate, and urgency measured by portable and HRM were also significantly correlated between techniques. For several parameters, differences between portable and HRM were statistically significant and the Bland Altman test was positive.Conclusions & InferencesAnorectal pressures and rectal sensation can be conveniently measured by portable manometry and are significantly correlated with high‐resolution manometry.