title: Can three-dimensional high-resolution anorectal manometry detect anal sphincter defects in patients with faecal incontinence?
abstract: OBJECTIVE
  Endoanal ultrasound (EAUS) is the gold standard for detecting anal sphincter defects in patients with faecal incontinence (FI), while anorectal manometry evaluates sphincter function. Three-dimensional high-resolution anorectal manometry (3D HRAM) is a newer modality with the potential to assess both sphincter function and anatomy. The purpose of the present study was to compare 3D HRAM with 3D EAUS for the detection of anal sphincter defects in patients with FI.
  
  
  METHODS
  A linkage analysis was performed between the 3D HRAM and 3D EAUS databases of a tertiary referral centre to identify patients with FI who underwent both 3D EAUS and 3D HRAM. With 3D HRAM, a defect was defined as any pressure measurement below 25 mmHg at rest with at least 18° of continuous expansion. The 3D HRAM findings were compared with those of 3D EAUS.
  
  
  RESULTS
  The study cohort included 39 patients with a mean age of 64.7 ± 15.2 years (SD); and 31 (79%) were female. Eight (21%) patients had an anal sphincter defect on EAUS with a median size of 93° (range 40°-136°). Fourteen (36%) had a defect shown by 3D HRAM with a median size of 144° (36°-180°). The sensitivity, specificity and positive and negative predictive values of 3D HRAM in detecting a sphincter defect were 75%, 74%, 43% and 92%, respectively.
  
  
  CONCLUSIONS
  With a negative predictive value of 92%, 3D HRAM may be a useful screening method for ruling out a sphincter defect in patients with FI, thereby avoiding both EAUS and manometry in selected patients.
authors.affiliation: Division of Gastroenterology, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: A
authors.initials: A
authors.lastname: Rezaie
authors.affiliation: Department of Internal Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: S
authors.initials: S
authors.lastname: Iriana
authors.affiliation: Division of Gastroenterology, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: M
authors.initials: M
authors.lastname: Pimentel
authors.affiliation: Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Murrell
authors.affiliation: Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: P
authors.initials: P
authors.lastname: Fleshner
authors.affiliation: Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: K
authors.initials: K
authors.lastname: Zaghiyan
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019160:Endosonography / Q000379:methods*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011312:Pressure; D011446:Prospective Studies; D012002:Rectal Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Anal sphincter defect; anal manometry; endoanal ultrasound; faecal incontinence