Neurogastroenterology and motility · 2025
Evaluation of a Modified London Protocol to Diagnose Defecation Disorders With High-Definition Anorectal Manometry.
Сравнительное исследованиеСтатьяОценочное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Lambiase Christian, Chiarioni Giuseppe, Rettura Francesco, Grosso Antonio, Tedeschi Riccardo, Cancelli Lorenzo, Bottari Andrea, Morganti Riccardo, de Bortoli Nicola, Bellini Massimo
Аннотация
BACKGROUND: Anorectal manometry (ARM) is useful to diagnose defecation disorders. The International Anorectal Physiology Working Group (IAPWG) introduced a standardized sequence of maneuvers into clinical practice to perform ARM (London Protocol). Regarding the "push" maneuver, excellent consensus among IAPWG experts was limited to the number of pushes and the interval between them. The aim of this study was to assess the diagnostic accuracy of simplified ARM protocols featuring various combinations of different push durations (15, 10 or 5 s) and numbers of push attempts (two or three).
METHODS: High-Definition ARM (HD-ARM) tracings from 142 patients (113 females, mean aged 54.7 ± 16.9) who underwent ARM for fecal incontinence (n = 37) or constipation (n = 105) were retrospectively reviewed. HD-ARM tracings were re-evaluated based on the following modifications to the London protocol: considering only the first two pushes; considering the first ten seconds of each push; considering the first ten seconds of the first two pushes; considering the first five seconds of each push; considering the first five seconds of the first two pushes. HD-ARM reports were redrawn because of these protocol modifications and were compared with the reports obtained using the IAPGW standard protocol in terms of manometric pattern and diagnosis.
RESULTS: The proposed modified protocols featuring ten- or fifteen-second pushes showed an almost perfect concordance compared with the standard of practice (k = 0.97), while the modified protocols featuring 5 s pushes showed only a fair/moderate diagnostic concordance. The latter was mainly linked to a transient increase in anal pressure (lasting on average four to five seconds).
CONCLUSIONS: Based on our results, two push efforts of ten seconds each may be enough to reach an accurate manometric diagnosis of defecation disorders. Five-second push may not be sufficient given the transient increase in anal pressure at the beginning of the push attempt. Performing only two push maneuvers of ten seconds each may reduce by 55 s the length of this cumbersome examination.
METHODS: High-Definition ARM (HD-ARM) tracings from 142 patients (113 females, mean aged 54.7 ± 16.9) who underwent ARM for fecal incontinence (n = 37) or constipation (n = 105) were retrospectively reviewed. HD-ARM tracings were re-evaluated based on the following modifications to the London protocol: considering only the first two pushes; considering the first ten seconds of each push; considering the first ten seconds of the first two pushes; considering the first five seconds of each push; considering the first five seconds of the first two pushes. HD-ARM reports were redrawn because of these protocol modifications and were compared with the reports obtained using the IAPGW standard protocol in terms of manometric pattern and diagnosis.
RESULTS: The proposed modified protocols featuring ten- or fifteen-second pushes showed an almost perfect concordance compared with the standard of practice (k = 0.97), while the modified protocols featuring 5 s pushes showed only a fair/moderate diagnostic concordance. The latter was mainly linked to a transient increase in anal pressure (lasting on average four to five seconds).
CONCLUSIONS: Based on our results, two push efforts of ten seconds each may be enough to reach an accurate manometric diagnosis of defecation disorders. Five-second push may not be sufficient given the transient increase in anal pressure at the beginning of the push attempt. Performing only two push maneuvers of ten seconds each may reduce by 55 s the length of this cumbersome examination.