title: Endorectal ultrasound and real-time elastography in patients with fecal incontinence following anorectal surgery: a prospective comparison evaluating short- and long-term outcomes in irradiated and non-irradiated patients.
abstract: OBJECTIVE
  Transanal real-time elastography (RTE) was demonstrated to yield valuable information regarding elastic properties of the anal sphincter in patients with fecal incontinence. We studied the role of RTE findings as a risk factor for the outcome of patients with fecal incontinence following anorectal surgery in irradiated and non-irradiated individuals and compared these observations with conventional B-mode/color Doppler EUS.
  
  
  METHODS
  90 patients with postsurgical fecal incontinence were included in this prospective monocentric study. Baseline and follow-up (after 3 weeks and 1 year) assessment included an incontinence severity score questionnaire, rectal manometry, B-mode/color Doppler EUS and RTE with quantitation of the sphincter elastograms.
  
  
  RESULTS
  81 patients could be finally assessed, in 24 patients (29.6%) a pathological elastogram with predominantly hard elements was found; logistic regression analysis revealed no significant association with the short- and long-term clinical outcome nor were any differences seen between irradiated and non-irradiated patients. Defined sphincter defects as seen with conventional EUS were significanntly associated with a worse short- and long-term outcome: odds ratio ORshort-term: 1.414 (1.107 - 1.807, p = 0.0101); ORlong-term: 1.675 (95% CI: 1.133 - 2.477; p = 0.0294). Submucosal thickening and hypervascularization were found more frequently in the irradiated group (p < 0.01).
  
  
  CONCLUSIONS
  RTE with quantitation of sphincter elastic properties yields no further diagnostic and prognostic information compared to conventional EUS in irradiated and non-irradiated patients and, therefore, cannot be regarded as a new tool in the assessment of those patients. Our data further confirm the view that defined sphincter defects may be a major risk factor for an unfavorable outcome.
authors.affiliation: Department of Gastroenterology and Metabolism, Klinik Ob der Tauber, Bad Mergentheim, RehaZentren Baden Württemberg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Allgayer
authors.forename: A
authors.initials: A
authors.lastname: Ignee
authors.forename: S
authors.initials: S
authors.lastname: Zipse
authors.forename: A
authors.initials: A
authors.lastname: Crispin
authors.forename: C F
authors.initials: CF
authors.lastname: Dietrich
mesh_terms: D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000528:radiation effects / Q000601:surgery*; D003199:Computer Systems; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods