title: Evacuation proctography: a reappraisal of normal variability.
abstract: OBJECTIVE
  Interpretation of evacuation proctography (EP) images is reliant on robust normative data. Previous studies of EP in asymptomatic subjects have been methodologically limited. The aim of this study was to provide parameters of normality for both genders using EP.
  
  
  METHODS
  Evacuation proctography was prospectively performed on 46 healthy volunteers (28 women). Proctograms were independently analysed by two reviewers. All established and some new variables of defaecatory structure and function were assessed objectively: anorectal dimensions; anorectal angle changes; evacuation time; percentage contrast evacuated; and incidence of rectal wall morphological 'abnormalities'.
  
  
  RESULTS
  Normal ranges were calculated for all main variables. Mean end-evacuation time was 88 s (95% CI: 63-113) in male subjects and 128 s (95% CI: 98-158) in female subjects; percentage contrast evacuated was 71% (95% CI: 63-80) in male subjects and 65% (95% CI: 58-72) in female subjects. Twenty-six (93%) of 28 female subjects had a rectocoele with a mean depth of 2.5 cm (upper limit = 3.9 cm). Recto-rectal intussusception was found in nine subjects (approximately 20% of both genders); however, recto-anal intussusception was not observed. Only rectal diameter differed significantly between genders. Qualitatively, three patterns of evacuation were present.
  
  
  CONCLUSIONS
  This study defines normal ranges for anorectal dimensions and parameters of emptying, as well as the incidence and characteristics of rectal-wall 'abnormalities' observed or derived from EP. These ranges can be applied clinically for subsequent disease comparison.
authors: Academic Surgical Unit (GI Physiology Unit), Centre of Digestive Diseases, Blizard Institute, Queen Mary University London, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK.
authors: S
authors: S
authors: Palit
authors: C
authors: C
authors: Bhan
authors: P J
authors: PJ
authors: Lunniss
authors: D J
authors: DJ
authors: Boyle
authors: M A
authors: MA
authors: Gladman
authors: C H
authors: CH
authors: Knowles
authors: S M
authors: SM
authors: Scott
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D003672:Defecation; D005260:Female; D006801:Humans; D007443:Intussusception / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012016:Reference Values; D055815:Young Adult
keywords: Proctography; defecation; defecography; normal values; rectal evacuation