title: Do endoflip assessments of anal sphincter distensibility provide more information on patients with fecal incontinence than high-resolution anal manometry?
abstract: BACKGROUND
  Anal manometry is the standard technique for evaluating anal sphincter function. However, the functional lumen imaging probe (EndoFLIP(®) ) can be used to measure sphincter distensibility during volume-controlled distensions. Our aims were (i) to assess anal distensibility in patients with fecal incontinence (FI) and in healthy subjects using the EndoFLIP(®) and (ii) to compare the results with anal pressures measured by 3D high-resolution manometry (3D-HRM) to determine whether the EndoFLIP(®) was more sensitive and specific for diagnosing FI than 3D-HRM.
  
  
  METHODS
  EndoFLIP(®) and 3D-HRM assessments of 34 female FI patients and 40 healthy female subjects were performed. Anal distensibility was measured as the median cross-sectional area at the narrowest point divided by the corresponding intra-bag pressure at rest and during peak voluntary contraction and was expressed in mm(2) /mmHg.
  
  
  RESULTS
  A 40-mL anal distensibility index was selected for further comparisons as it provided the best discrimination between the FI patients and the healthy subjects. The index was significantly higher in the FI patients than in the healthy subjects at rest (p = 1.10(-4) ) and during voluntary contraction (p = 1.10(-4) ). The index at rest and during voluntary contraction appeared to be more appropriate than anal pressures for discriminating between FI patients and healthy subjects.
  
  
  CONCLUSIONS
  The present study confirmed that FI is associated with an abnormally high distensibility index at rest and during voluntary contraction. The ability of the distensibility index to discriminate between FI patients and healthy subjects was significantly better than anal pressure.
authors.affiliation: INSERM U1073, Service de Physiologie Digestive, CHU Rouen, INSERM CIC 0204 Rouen, Rouen, France.
authors.forename: G
authors.initials: G
authors.lastname: Gourcerol
authors.affiliation: INSERM U1073, Service de Physiologie Digestive, CHU Rouen, INSERM CIC 0204 Rouen, Rouen, France.
authors.forename: S
authors.initials: S
authors.lastname: Granier
authors.affiliation: INSERM U1073, Service de Chirurgie Digestive, CHU Rouen, Rouen, France.
authors.forename: V
authors.initials: V
authors.lastname: Bridoux
authors.affiliation: Unité de Biostatistiques, Rouen, France.
authors.forename: J F
authors.initials: JF
authors.lastname: Menard
authors.affiliation: INSERM U1073, Service d'Hépato-Gastroentérologie, CHU Rouen, Rouen, France.
authors.forename: P
authors.initials: P
authors.lastname: Ducrotté
authors.affiliation: INSERM U1073, Service de Physiologie Digestive, CHU Rouen, INSERM CIC 0204 Rouen, Rouen, France.
authors.forename: A M
authors.initials: AM
authors.lastname: Leroi
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D019540:Area Under Curve; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D012372:ROC Curve
keywords: anal compliance; anal distensibility; anal manometry; endoFLIP®; fecal incontinence