应用水灌注系统的高分辨率肛门直肠测压对协同失调性排便障碍的分类的观察者内和观察者间一致性。

Intra- and inter-observer agreement in the classification of dyssynergic defecation on high-resolution anorectal manometry using water-perfusion system.

机构信息

Department of Gastroenterology, Seth G S Medical College and K E M Hospital, New Building, 11th floor, Parel, Mumbai, 400 012, India.

Department of Gastroenterology, P D Hinduja Memorial Hospital, Mumbai, 400 016, India.

出版信息

Indian J Gastroenterol. 2022 Aug;41(4):336-342. doi: 10.1007/s12664-022-01239-2. Epub 2022 Sep 3.

DOI:10.1007/s12664-022-01239-2

PMID:36056276

Abstract

BACKGROUND AND AIMS

Dyssynergic defecation (DD) classified on anorectal manometry is based on variations in anal sphincter pressures and rectal pressure generated during bearing down. There is a paucity of data on intra- and inter-observer agreement in the classification of DD on high-resolution anorectal manometry (HRAM) using a water-perfusion system.

METHODS

This cross-sectional observational study was conducted between June 2014 and May 2016 on 70 adult patients with DD. Observer 1 did the baseline analysis and reanalyzed the readings at least 6 months later, blinded to the initial analysis results (intra-observer variability). Four other blinded observers (5-25 years in anorectal manometry and minimum 5 years of experience in HRAM) then individually analyzed the manometry data (inter-observer variability).

RESULTS

Intra-observer agreement was excellent (kappa 0.862) for classifying DD. Agreement between the six observations (i.e. two from observer 1 and four from independent observers) was also good (kappa 0.632). The highest agreement was for type 4 DD (kappa 0.738), followed by type 1 (0.680), type 2 (0.664), and type 3 (0.537). Cronbach's alpha value was 0.93, suggesting excellent internal consistency.

CONCLUSION

The diagnosis of the types of DD on anorectal manometry using a water-perfusion system has excellent intra-observer and good inter-observer agreement .

摘要

背景与目的

肛肠测压中根据肛门括约肌压力和用力排便时直肠压力的变化来诊断协同失调性排便（DD）。使用注水系统的高分辨率肛肠测压（HRAM）对 DD 进行分类时，其观察者内和观察者间的一致性数据有限。

方法

本横断面观察性研究于 2014 年 6 月至 2016 年 5 月在 70 例 DD 成年患者中进行。观察者 1 进行基线分析，并在至少 6 个月后对读数进行重新分析（观察者内变异性），对初始分析结果不了解。然后，另外 4 位盲法观察者（肛肠测压 5-25 年，HRAM 至少 5 年经验）对测压数据进行单独分析（观察者间变异性）。

结果

DD 分类的观察者内一致性非常好（kappa 值为 0.862）。六次观察（即观察者 1 的两次和独立观察者的四次）之间的一致性也很好（kappa 值为 0.632）。一致性最高的是 4 型 DD（kappa 值为 0.738），其次是 1 型（kappa 值为 0.680）、2 型（kappa 值为 0.664）和 3 型（kappa 值为 0.537）。Cronbach's alpha 值为 0.93，提示内部一致性极好。