球囊排空试验的验证：可重复性及与肛肠测压和肌电图检查结果的一致性。

Validation of the balloon evacuation test: reproducibility and agreement with findings from anorectal manometry and electromyography.

机构信息

Division of Gastroenterology, University of Verona, A.O.U.I., Verona, Italy; Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

出版信息

Clin Gastroenterol Hepatol. 2014 Dec;12(12):2049-54. doi: 10.1016/j.cgh.2014.03.013. Epub 2014 Mar 24.

DOI:10.1016/j.cgh.2014.03.013

PMID:24674941

Abstract

BACKGROUND & AIMS: The balloon evacuation test (BET) measures the time required to evacuate a balloon filled with 50 mL water; it has been incorporated into many algorithms for diagnosis of pelvic floor dyssynergia. We aimed to assess the reproducibility of the BET, determine the upper limit of normal, and assess its concordance with evaluation of pelvic floor dyssynergia by anorectal manometry (ARM) and pelvic floor surface electromyography (EMG).

METHODS

The BET was tested in 286 consecutive patients with chronic constipation (mean age, 44 years; 91% female) before and after 30 days of conservative treatment at a tertiary gastroenterology clinic in Italy from March 2010 through May 2012. The BET was tested twice, 7 days apart, in 40 healthy individuals (controls: mean age, 38 years; 92% female). The 238 constipated patients who responded incompletely to conservative therapy were examined by ARM, EMG, and digital rectal examination. Forty-seven patients with conflicting ARM and BET results underwent defecography.

RESULTS

The balloon was evacuated within 1 minute by 37 controls (93%; 3 individuals required 1-2 minutes). Among patients with constipation, 148 (52%) passed the balloon within 5 minutes (110 passed the balloon in 1 minute, 35 passed it in 1-2 minutes, and 3 passed it in 2-5 minutes). The BET showed perfect reproducibility in 280 of the patients with constipation (98%) when a time less than 2 minutes was set as abnormal. The level of agreement between BET and ARM for dyssynergia was 78%, and between BET and EMG it was 83%. Thirty-two patients had abnormal results from the BET but normal results from ARM; 31 cases had inadequate straining (n = 11) or anatomic defects (n = 20), which could account for the abnormal findings from BET.

CONCLUSIONS

The BET is reliable for analysis of pelvic floor dyssynergia; the optimal upper limit of normal is 2 minutes. Findings from the BET have a high level of agreement with those from ARM and EMG.

摘要

背景与目的

球囊排空试验（BET）测量充满 50 毫升水的球囊排空所需的时间；它已被纳入许多盆底功能障碍协同失调的诊断算法中。我们旨在评估 BET 的可重复性，确定正常值上限，并评估其与直肠测压（ARM）和盆底表面肌电图（EMG）评估盆底功能障碍协同失调的一致性。

方法

2010 年 3 月至 2012 年 5 月，在意大利一家三级胃肠病诊所，对 286 例慢性便秘患者（平均年龄 44 岁，91%为女性）进行了 BET 测试，这些患者在进行了 30 天的保守治疗前后接受了测试。在 40 名健康个体（对照组：平均年龄 38 岁，92%为女性）中，BET 测试在 7 天内进行了两次。对 238 例对保守治疗反应不完全的便秘患者进行了 ARM、EMG 和数字直肠检查。47 例 ARM 和 BET 结果不一致的患者进行了排粪造影检查。

结果

37 名对照组（93%；3 名个体需要 1-2 分钟）在 1 分钟内排空了球囊。在便秘患者中，148 名（52%）在 5 分钟内排空了球囊（110 名在 1 分钟内排空，35 名在 1-2 分钟内排空，3 名在 2-5 分钟内排空）。当将小于 2 分钟的时间设置为异常时，BET 在 280 例便秘患者中显示出完美的可重复性（98%）。BET 与 ARM 对协同失调的一致性水平为 78%，与 EMG 的一致性水平为 83%。32 例患者 BET 结果异常而 ARM 结果正常；31 例存在不足（n=11）或解剖缺陷（n=20），这可以解释 BET 异常的发现。