title: Prospective multicenter trial comparing echodefecography with defecography in the assessment of anorectal dysfunction in patients with obstructed defecation.
abstract: 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.
  
  
  METHODS
  Multicenter, prospective observational study.
  
  
  METHODS
  Women with symptoms of obstructed defecation.
  
  
  METHODS
  Six centers for colorectal surgery (3 in Brazil, 1 in Texas, 1 in Florida, and 1 in Venezuela).
  
  
  METHODS
  Defecography was performed after inserting 150 mL of barium paste in the rectum. Echodefecography was performed with a 2050 endoprobe through 3 automatic scans.
  
  
  METHODS
  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 evaluated: median 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Medicine of the Federal University of Ceara, Fortaleza, Brazil. sregadas@hospitalsaocarlos.com.br
authors.forename: F Sergio P
authors.initials: FS
authors.lastname: Regadas
authors.forename: Eric M
authors.initials: EM
authors.lastname: Haas
authors.forename: Maher A
authors.initials: MA
authors.lastname: Abbas
authors.forename: J
authors.initials: J
authors.lastname: Marcio Jorge
authors.forename: Angelita
authors.initials: A
authors.lastname: Habr-Gama
authors.forename: Dana
authors.initials: D
authors.lastname: Sands
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
authors.forename: Ingrid
authors.initials: I
authors.lastname: Melo-Amaral
authors.forename: Carlos
authors.initials: C
authors.lastname: Sardiñas
authors.forename: Doryane M
authors.initials: DM
authors.lastname: Lima
authors.forename: Univaldo E
authors.initials: UE
authors.lastname: Sagae
authors.forename: Evaldo U
authors.initials: EU
authors.lastname: Sagae
authors.forename: Sthela M
authors.initials: SM
authors.lastname: Murad-Regadas
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology; D001466:Barium Sulfate; D003248:Constipation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003287:Contrast Media; D019841:Defecography / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D004733:Enema; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007443:Intussusception / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D020047:Rectocele / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate