ArticleDigestive diseases and sciences2022
Redundancy in the International Anorectal Physiology Working Group Manometry Protocol: A Diagnostic Accuracy Study in Fecal Incontinence.
Article in Digestive diseases and sciences, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Real‑world Application of the International Anorectal Physiology Working Group Standardized Protocol and London Classification: A Multi‑country Cross‑sectional Survey of Anorectal Manometry Practice in Asia.Journal of neurogastroenterology and motility · 2026Article
- The Clinical Utility of Anorectal Manometry: A Review of Current Practices.Gastro hep advances · 2025Review
- Optimizing the Utility of Anorectal Manometry for Diagnosis and Therapy: A Roundtable Review and Recommendations.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2023Review
- Automated extraction of anorectal pressures from high-resolution manometry reports.Neurogastroenterology and motility · 2022Article
- Optimizing techniques for measuring anal resting and squeeze pressures with high-resolution manometry.Neurogastroenterology and motility · 2022Article
- Review of the indications, methods, and clinical utility of anorectal manometry and the rectal balloon expulsion test.Neurogastroenterology and motility · 2022Review
- Faecal incontinence in adults.Nature reviews. Disease primers · 2022Review
- Staying in HRAM's Way: Tweaking the London Classification for Disorders of Anorectal Function.Digestive diseases and sciences · 2022Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAnorectal manometry (ARM) is essential for identifying sphincteric dysfunction. The International Anorectal Physiology Working Group (IAPWG) protocol and London Classification provide a standardized format for performing and interpreting ARM. However, there is scant evidence to support timing and number of constituent maneuvers.
aimsTo assess the impact of protocol modification on diagnostic accuracy in patients with fecal incontinence.
methodsRetrospective analysis of high-resolution ARM recordings from consecutive patients based on the current IAPWG protocol and modifications thereof: (1) baseline rest period (60 vs. 30 vs. 10 s); (2) number of abnormal short squeezes (SS) out of 3 (SS1/SS2/SS3) based on maximal incremental squeeze pressures over 5 s; (3) resting anal pressures (reflecting recovery) at 25-30 versus 15-20 s after SS1.
resultsOne hundred patients (86 F, median age 55 [IQR: 39-65]; median St. Mark's incontinence score 14 [10-17]) were studied. 26% and 8% had anal hypotonia and hypertonia, respectively. Compared with 60-s resting pressure, measurements had perfect correlation (κ = 1.0) over 30 s, and substantial correlation (κ = 0.85) over 10 s. After SS1, SS2, and SS3, 43%, 49%, and 46% had anal hypocontractility, respectively. Correlation was substantial between SS1 and SS2 (κ = 0.799) and almost perfect between SS2 and SS3 (κ = 0.9). Compared to resting pressure of 5 s before SS1, pressure recordings at 25-30 and 15-20 s after SS1 were significantly correlated.
conclusionsA 30-s resting anal pressure, analysis of 2 short-squeezes with a 20-s between-maneuver recovery optimizes study duration without compromising diagnostic accuracy. These findings indicate the IAPWG protocol has redundancy.
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