Sauter M, Heinrich H, Fox M, Misselwitz B, Halama M, Schwizer W, Fried M, Fruehauf H
Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Department of Internal Medicine, Triemli Hospital, Zurich, Switzerland.
Neurogastroenterol Motil. 2014 May;26(5):685-95. doi: 10.1111/nmo.12317. Epub 2014 Feb 12.
Measurements of anorectal function using high-resolution anorectal manometry (HR-ARM) and rectal barostat technology provide more reliable results than standard ARM with an elastic balloon; however, HR-ARM results have not been compared to ARM and standard barostat protocols are impractical in routine clinical practice. The aim of this study was to validate HR-ARM against standard ARM and standard barostat against a novel Rapid Barostat Bag (RBB) measurement and elastic balloon measurements of rectal function.
Twenty-six healthy volunteers (15 female, 11 male, 19-52 years) were studied. Measurements of anal function and simulated defecation were compared for 12-sensor HR-ARM and 6-sensor standard ARM using line plots from the same recording. Rectal capacity, compliance, and sensation (volume threshold) were measured by elastic balloon, standard barostat, and RBB methods using stepwise inflation of a 700-mL polyethylene bag to 40 mmHg distension by electronic barostat and handheld syringe monitored by sphygmo-manometer, respectively. Results are reported as mean ± SD. Bland-Altman plots and correlation coefficients (r) for measurements were calculated.
There was excellent agreement between HR- and standard ARM measurements (r > 0.86, <25 mmHg difference) and between standard barostat and RBB measurements of rectal capacity (r = 0.97, <25 mL difference). Correlation coefficients of threshold volumes for initial perception, urgency and discomfort were 0.37, 0.71, and 0.95, respectively. No significant correlation was present with elastic balloon measurements. Time to complete studies was shorter for HR-ARM than standard ARM and for RBB than standard barostat in historical controls.
CONCLUSIONS & INFERENCES: HR-ARM with RBB measurements of anorectal function provides quick and reasonably accurate measurements of continence function suitable for use in routine clinical practice (ClinicalTrial.gov NCT01456442).
与使用弹性球囊的标准肛管直肠测压法相比，采用高分辨率肛管直肠测压法（HR-ARM）和直肠恒压器技术测量肛管直肠功能可提供更可靠的结果；然而，尚未将HR-ARM的结果与标准肛管直肠测压法进行比较，且标准恒压器方案在常规临床实践中不实用。本研究的目的是针对标准肛管直肠测压法验证HR-ARM，针对新型快速恒压器袋（RBB）测量以及直肠功能的弹性球囊测量验证标准恒压器。
对26名健康志愿者（15名女性，11名男性，年龄19 - 52岁）进行研究。使用来自同一记录的线图，比较12传感器HR-ARM和6传感器标准肛管直肠测压法对肛门功能和模拟排便的测量结果。分别通过弹性球囊、标准恒压器和RBB方法，使用电子恒压器将一个700毫升的聚乙烯袋逐步充气至40毫米汞柱扩张，以及使用血压计监测的手持注射器，测量直肠容量、顺应性和感觉（容量阈值）。结果以平均值±标准差报告。计算测量结果的布兰德-奥特曼图和相关系数（r）。
HR-ARM与标准肛管直肠测压法测量结果之间具有极好的一致性（r > 0.86，差值<25毫米汞柱），标准恒压器与RBB测量直肠容量结果之间也具有极好的一致性（r = 0.97，差值<25毫升）。初始感知、急迫感和不适感的阈值容量相关系数分别为0.37、0.71和0.95。与弹性球囊测量结果无显著相关性。在历史对照中，HR-ARM完成研究的时间比标准肛管直肠测压法短，RBB完成研究的时间比标准恒压器短。
采用RBB测量肛管直肠功能的HR-ARM可提供快速且相当准确的控便功能测量结果，适用于常规临床实践（ClinicalTrial.gov NCT01456442）。
