A novel high-resolution anorectal manometry parameter based on a three-dimensional integrated pressurized volume of a spatiotemporal plot, for predicting balloon expulsion in asymptomatic normal individuals.
BACKGROUND
Anorectal manometry with simulated evacuation (SE) has limited applicability in predicting balloon expulsion (BE) test results. The newly developed high-resolution anorectal manometry (HRAM) technique can yield spatiotemporal plots with three-dimensional pressurization. We aimed to define new parameters based on three-dimensional integrated pressurized volume (IPV) for predicting the BE test results in asymptomatic normal individuals.


METHODS
Fifty-four asymptomatic healthy individuals were prospectively enrolled. BE tests were performed using 50 mL of water, and a requirement of more than 1 min was considered as delayed BE. HRAM profiles were converted into ASCII files and analyzed using a MATLAB program. A three-dimensional IPV was plotted after transforming the data to a cubic spline interpolation followed by resampling the manometry position at 0.1-cm intervals.


RESULTS
Eight of the 54 (15%) individuals demonstrated delayed BE. Conventional manometric profiles did not differ significantly between cases of early and delayed BE. Receiver-operator characteristic curve analysis revealed that the ratio of the IPVs of the upper 1 cm to the lower 4 cm of the anorectal canal with balloon distension was more predictable of the BE results (area under curve, 0.73: 95% confidence interval, 0.53-0.92; p = 0.04) than the other IPVs or their ratios.


CONCLUSIONS
The newly developed IPV methods could predict delayed BE tests during SE better than the conventional parameters defined on the basis of linear waves. Well-designed prospective trials on a large number of subjects are warranted to validate the clinical application of this novel parameter.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Kee Wook
KW
Jung
Segyeong
S
Joo
Dong-Hoon
DH
Yang
In Ja
IJ
Yoon
So Young
SY
Seo
Seon-Ok
SO
Kim
Jungbok
J
Lee
Hyo Jeong
HJ
Lee
Kyung Jo
KJ
Kim
Byong Duk
BD
Ye
Jeong-Sik
JS
Byeon
Hwoon-Yong
HY
Jung
Suk-Kyun
SK
Yang
Jin-Ho
JH
Kim
Seung-Jae
SJ
Myung
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology*; D003672:Defecation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D012016:Reference Values; D055815:Young Adult
anorectal manometry; constipation; high-resolution manometry