ArticleInternational journal of colorectal disease2005
Digital rectal examination compares favourably with conventional water-soluble contrast enema in the assessment of anastomotic healing after low rectal excision: a cohort study.
Article in International journal of colorectal disease, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Utility of contrast enema to assess anastomotic integrity and the natural history of radiological leaks after low rectal surgery: systematic review and meta-analysis.International journal of colorectal disease · 2015Pooled it
- Less is more-the best test for anastomotic leaks in rectal cancer patients prior to ileostomy reversal.International journal of colorectal disease · 2021Review
- Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients.Journal of personalized medicine · 2021Review
- Is water-soluble contrast enema examination for integrity of rectal anastomosis necessary prior to ileostomy reversal?JGH open : an open access journal of gastroenterology and hepatology · 2020Article
- Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?European radiology · 2019Article
- Clinical value of pouchogram prior to ileostomy closure after ileal pouch anal anastomosis.Techniques in coloproctology · 2018Article
- Before and after Anorectal Surgery: Which Information Is Needed from the Functional Laboratory?Visceral medicine · 2018Review
- Considerations in Stoma Reversal.Clinics in colon and rectal surgery · 2017Review
- Water-Soluble Enema Prior to Ileostomy Closure in Patients Undergoing Low Anterior Resection: Is It Necessary?Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2016Article
- Is the routine use of a water-soluble contrast enema prior to closure of a loop ileostomy necessary? A review of a single institution experience.World journal of surgical oncology · 2015Article
- Water soluble contrast enema examination of the integrity of the rectal anastomosis prior to loop ileostomy reversal may be superfluous.International journal of colorectal disease · 2015Article
- Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature.World journal of gastrointestinal surgery · 2014Review
- Radiological evaluation of colorectal anastomoses.International journal of colorectal disease · 2008Article
Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAssessment of healing after low colorectal, colo-anal or ileo-pouch anal anastomosis is routinely performed with a water-soluble contrast enema (WSCE) prior to the reversal of the defunctioning stoma. Interpretation of these radiographs is sometimes difficult and imprecise. As these anastomoses are within the reach of a simple digital rectal examination (DRE), this approach is proposed as an effective and accurate adjunct. PATIENTS AND
methodsThis is a prospective cohort study recruiting patients who had undergone a low colorectal, colo-anal or ileo-pouch anal anastomosis with a diversion stoma. Anastomotic healing was assessed with a DRE in the clinic followed by the conventional WSCE. Anastomotic defects on digital examination and leaks on WSCEs were studied.
resultsThere were 195 patients recruited with a total of 202 paired assessments from 182 patients over 45 months. Six months after closure of the study, 174 patients had their stomas reversed. Thirteen examinations with WSCE showed pathology but were normal on digital examination (false positive rate of 6.4% for WSCE). These patients had their stomas reversed with no subsequent problems. Seven patients had an abnormal DRE but had a normal enema study (false negative rate of 3.5% for WSCE). These were large defects with pus and allowed the tip of the examining finger through. Delayed reversal of the stomas in these patients probably avoided continuing pelvic sepsis. The DRE was accurate in all instances except in the detection of a minor fistula in three patients. The sensitivity of the DRE in the detection of anastomotic pathology was 98.4%.
conclusionThe DRE yields additional and reliable information compared with the conventional water-soluble enema study in the assessment of anastomotic healing prior to stoma closure. In the experienced surgeon, it yielded more useful clinical information than the enema study.
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