Methods of anorectal manometry vary widely in clinical practice: Results from an international survey

The International Anorectal Physiology Working Party Group (IAPWG)

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Ano-rectal manometry (ARM) is the most commonly performed investigation for assessment of anorectal dysfunction. Its use is supported by expert consensus documents and international guidelines. Variation in technology, data acquisition, and analysis affect results and clinical interpretation. This study examined variation in ARM between institutions to establish the status of current practice. Methods: A 50-item web-based questionnaire assessing analysis and interpretation of ARM was distributed by the International Anorectal Physiology Working Group via societies representing practitioners that perform ARM. Study methodology and performance characteristics between institutions were compared. Key Results: One hundred and seven complete responses were included from 30 countries. Seventy-nine (74%) institutions performed at least two studies per week. Forty-nine centers (47%) applied conventional ARM (≤8 pressure sensors) and 57 (53%) high-resolution ARM (HR-ARM). Specialist centers were most likely to use HR-ARM compared to regional hospitals and office-based practice (63% vs 37%). Most conventional ARM systems used water-perfused technology (34/49); solid-state hardware was more frequently used in centers performing HR-ARM (44/57). All centers evaluated rest and squeeze. There was marked variation in the methods used to report results of maneuvers. No two centers had identical protocols for patient preparation, setup, study, and data interpretation, and no center fully complied with published guidelines. Conclusions & Inferences: There is significant discrepancy in methods for data acquisition, analysis, and interpretation of ARM. This is likely to impact clinical interpretation, transfer of data between institutions, and research collaboration. There is a need for expert international co-operation to standardize ARM.

Original languageEnglish (US)
Article numbere13016
JournalNeurogastroenterology and Motility
Volume29
Issue number8
DOIs
StatePublished - Aug 1 2017

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Manometry
Guidelines
Technology
Surveys and Questionnaires
Pressure
Water

Keywords

  • anal manometry
  • anorectal dysfunction
  • anorectal manometry
  • anorectal physiology
  • constipation
  • faecal/fecal incontinence
  • high-resolution anorectal manometry

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

Cite this

Methods of anorectal manometry vary widely in clinical practice : Results from an international survey. / The International Anorectal Physiology Working Party Group (IAPWG).

In: Neurogastroenterology and Motility, Vol. 29, No. 8, e13016, 01.08.2017.

Research output: Contribution to journalArticle

The International Anorectal Physiology Working Party Group (IAPWG). / Methods of anorectal manometry vary widely in clinical practice : Results from an international survey. In: Neurogastroenterology and Motility. 2017 ; Vol. 29, No. 8.
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abstract = "Background: Ano-rectal manometry (ARM) is the most commonly performed investigation for assessment of anorectal dysfunction. Its use is supported by expert consensus documents and international guidelines. Variation in technology, data acquisition, and analysis affect results and clinical interpretation. This study examined variation in ARM between institutions to establish the status of current practice. Methods: A 50-item web-based questionnaire assessing analysis and interpretation of ARM was distributed by the International Anorectal Physiology Working Group via societies representing practitioners that perform ARM. Study methodology and performance characteristics between institutions were compared. Key Results: One hundred and seven complete responses were included from 30 countries. Seventy-nine (74{\%}) institutions performed at least two studies per week. Forty-nine centers (47{\%}) applied conventional ARM (≤8 pressure sensors) and 57 (53{\%}) high-resolution ARM (HR-ARM). Specialist centers were most likely to use HR-ARM compared to regional hospitals and office-based practice (63{\%} vs 37{\%}). Most conventional ARM systems used water-perfused technology (34/49); solid-state hardware was more frequently used in centers performing HR-ARM (44/57). All centers evaluated rest and squeeze. There was marked variation in the methods used to report results of maneuvers. No two centers had identical protocols for patient preparation, setup, study, and data interpretation, and no center fully complied with published guidelines. Conclusions & Inferences: There is significant discrepancy in methods for data acquisition, analysis, and interpretation of ARM. This is likely to impact clinical interpretation, transfer of data between institutions, and research collaboration. There is a need for expert international co-operation to standardize ARM.",
keywords = "anal manometry, anorectal dysfunction, anorectal manometry, anorectal physiology, constipation, faecal/fecal incontinence, high-resolution anorectal manometry",
author = "{The International Anorectal Physiology Working Party Group (IAPWG)} and Carrington, {E. V.} and H. Heinrich and Knowles, {C. H.} and Rao, {S. S.} and Rao, {Satish Sanku Chander} and Scott, {S. M.} and Emma Carrington and Henriette Heinrich and Charles Knowles and Mark Scott and Henriette Heinrich and Satish Rao and Mark Fox and Donato Altomare and Adil Bharucha and Rebecca Burgell and Guiseppe Chiarioni and Phil Dinning and Richelle Felt-Bersma and Ridzuan Farouk and Jung, {Kee Wook} and Myung, {Seung Jae} and Anthony Lembo and Alison Malcolm and Fran{\cc}ois Mion and Sabine Roman and Christian Pehl and Troche, {Jose Remes} and Robert Reveille and Carolynne Vaizey and William Whitehead and Wong, {Rueben K.}",
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AU - The International Anorectal Physiology Working Party Group (IAPWG)

AU - Carrington, E. V.

AU - Heinrich, H.

AU - Knowles, C. H.

AU - Rao, S. S.

AU - Rao, Satish Sanku Chander

AU - Scott, S. M.

AU - Carrington, Emma

AU - Heinrich, Henriette

AU - Knowles, Charles

AU - Scott, Mark

AU - Heinrich, Henriette

AU - Rao, Satish

AU - Fox, Mark

AU - Altomare, Donato

AU - Bharucha, Adil

AU - Burgell, Rebecca

AU - Chiarioni, Guiseppe

AU - Dinning, Phil

AU - Felt-Bersma, Richelle

AU - Farouk, Ridzuan

AU - Jung, Kee Wook

AU - Myung, Seung Jae

AU - Lembo, Anthony

AU - Malcolm, Alison

AU - Mion, François

AU - Roman, Sabine

AU - Pehl, Christian

AU - Troche, Jose Remes

AU - Reveille, Robert

AU - Vaizey, Carolynne

AU - Whitehead, William

AU - Wong, Rueben K.

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N2 - Background: Ano-rectal manometry (ARM) is the most commonly performed investigation for assessment of anorectal dysfunction. Its use is supported by expert consensus documents and international guidelines. Variation in technology, data acquisition, and analysis affect results and clinical interpretation. This study examined variation in ARM between institutions to establish the status of current practice. Methods: A 50-item web-based questionnaire assessing analysis and interpretation of ARM was distributed by the International Anorectal Physiology Working Group via societies representing practitioners that perform ARM. Study methodology and performance characteristics between institutions were compared. Key Results: One hundred and seven complete responses were included from 30 countries. Seventy-nine (74%) institutions performed at least two studies per week. Forty-nine centers (47%) applied conventional ARM (≤8 pressure sensors) and 57 (53%) high-resolution ARM (HR-ARM). Specialist centers were most likely to use HR-ARM compared to regional hospitals and office-based practice (63% vs 37%). Most conventional ARM systems used water-perfused technology (34/49); solid-state hardware was more frequently used in centers performing HR-ARM (44/57). All centers evaluated rest and squeeze. There was marked variation in the methods used to report results of maneuvers. No two centers had identical protocols for patient preparation, setup, study, and data interpretation, and no center fully complied with published guidelines. Conclusions & Inferences: There is significant discrepancy in methods for data acquisition, analysis, and interpretation of ARM. This is likely to impact clinical interpretation, transfer of data between institutions, and research collaboration. There is a need for expert international co-operation to standardize ARM.

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KW - anal manometry

KW - anorectal dysfunction

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KW - anorectal physiology

KW - constipation

KW - faecal/fecal incontinence

KW - high-resolution anorectal manometry

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