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Endorectal ultrasound and real-time elastography in patients with fecal incontinence following anorectal surgery: a prospective comparison evaluating short- and long-term outcomes in irradiated and non-irradiated patients.
Z Gastroenterol. 2012 Dec; 50(12):1281-6.ZG

Abstract

BACKGROUND AND AIMS

Transanal real-time elastography (RTE) was demonstrated to yield valuable information regarding elastic properties of the anal sphincter in patients with fecal incontinence. We studied the role of RTE findings as a risk factor for the outcome of patients with fecal incontinence following anorectal surgery in irradiated and non-irradiated individuals and compared these observations with conventional B-mode/color Doppler EUS.

PATIENTS AND METHODS

90 patients with postsurgical fecal incontinence were included in this prospective monocentric study. Baseline and follow-up (after 3 weeks and 1 year) assessment included an incontinence severity score questionnaire, rectal manometry, B-mode/color Doppler EUS and RTE with quantitation of the sphincter elastograms.

RESULTS

81 patients could be finally assessed, in 24 patients (29.6%) a pathological elastogram with predominantly hard elements was found; logistic regression analysis revealed no significant association with the short- and long-term clinical outcome nor were any differences seen between irradiated and non-irradiated patients. Defined sphincter defects as seen with conventional EUS were significanntly associated with a worse short- and long-term outcome: odds ratio ORshort-term: 1.414 (1.107 - 1.807, p = 0.0101); ORlong-term: 1.675 (95% CI: 1.133 - 2.477; p = 0.0294). Submucosal thickening and hypervascularization were found more frequently in the irradiated group (p < 0.01).

CONCLUSION

RTE with quantitation of sphincter elastic properties yields no further diagnostic and prognostic information compared to conventional EUS in irradiated and non-irradiated patients and, therefore, cannot be regarded as a new tool in the assessment of those patients. Our data further confirm the view that defined sphincter defects may be a major risk factor for an unfavorable outcome.

Authors+Show Affiliations

Department of Gastroenterology and Metabolism, Klinik Ob der Tauber, Bad Mergentheim, RehaZentren Baden Württemberg, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

23225555

Citation

Allgayer, H, et al. "Endorectal Ultrasound and Real-time Elastography in Patients With Fecal Incontinence Following Anorectal Surgery: a Prospective Comparison Evaluating Short- and Long-term Outcomes in Irradiated and Non-irradiated Patients." Zeitschrift Fur Gastroenterologie, vol. 50, no. 12, 2012, pp. 1281-6.
Allgayer H, Ignee A, Zipse S, et al. Endorectal ultrasound and real-time elastography in patients with fecal incontinence following anorectal surgery: a prospective comparison evaluating short- and long-term outcomes in irradiated and non-irradiated patients. Z Gastroenterol. 2012;50(12):1281-6.
Allgayer, H., Ignee, A., Zipse, S., Crispin, A., & Dietrich, C. F. (2012). Endorectal ultrasound and real-time elastography in patients with fecal incontinence following anorectal surgery: a prospective comparison evaluating short- and long-term outcomes in irradiated and non-irradiated patients. Zeitschrift Fur Gastroenterologie, 50(12), 1281-6. https://doi.org/10.1055/s-0032-1313000
Allgayer H, et al. Endorectal Ultrasound and Real-time Elastography in Patients With Fecal Incontinence Following Anorectal Surgery: a Prospective Comparison Evaluating Short- and Long-term Outcomes in Irradiated and Non-irradiated Patients. Z Gastroenterol. 2012;50(12):1281-6. PubMed PMID: 23225555.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endorectal ultrasound and real-time elastography in patients with fecal incontinence following anorectal surgery: a prospective comparison evaluating short- and long-term outcomes in irradiated and non-irradiated patients. AU - Allgayer,H, AU - Ignee,A, AU - Zipse,S, AU - Crispin,A, AU - Dietrich,C F, Y1 - 2012/12/07/ PY - 2012/12/11/entrez PY - 2012/12/12/pubmed PY - 2013/6/25/medline SP - 1281 EP - 6 JF - Zeitschrift fur Gastroenterologie JO - Z Gastroenterol VL - 50 IS - 12 N2 - BACKGROUND AND AIMS: Transanal real-time elastography (RTE) was demonstrated to yield valuable information regarding elastic properties of the anal sphincter in patients with fecal incontinence. We studied the role of RTE findings as a risk factor for the outcome of patients with fecal incontinence following anorectal surgery in irradiated and non-irradiated individuals and compared these observations with conventional B-mode/color Doppler EUS. PATIENTS AND METHODS: 90 patients with postsurgical fecal incontinence were included in this prospective monocentric study. Baseline and follow-up (after 3 weeks and 1 year) assessment included an incontinence severity score questionnaire, rectal manometry, B-mode/color Doppler EUS and RTE with quantitation of the sphincter elastograms. RESULTS: 81 patients could be finally assessed, in 24 patients (29.6%) a pathological elastogram with predominantly hard elements was found; logistic regression analysis revealed no significant association with the short- and long-term clinical outcome nor were any differences seen between irradiated and non-irradiated patients. Defined sphincter defects as seen with conventional EUS were significanntly associated with a worse short- and long-term outcome: odds ratio ORshort-term: 1.414 (1.107 - 1.807, p = 0.0101); ORlong-term: 1.675 (95% CI: 1.133 - 2.477; p = 0.0294). Submucosal thickening and hypervascularization were found more frequently in the irradiated group (p < 0.01). CONCLUSION: RTE with quantitation of sphincter elastic properties yields no further diagnostic and prognostic information compared to conventional EUS in irradiated and non-irradiated patients and, therefore, cannot be regarded as a new tool in the assessment of those patients. Our data further confirm the view that defined sphincter defects may be a major risk factor for an unfavorable outcome. SN - 1439-7803 UR - https://www.unboundmedicine.com/medline/citation/23225555/Endorectal_ultrasound_and_real_time_elastography_in_patients_with_fecal_incontinence_following_anorectal_surgery:_a_prospective_comparison_evaluating_short__and_long_term_outcomes_in_irradiated_and_non_irradiated_patients_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0032-1313000 DB - PRIME DP - Unbound Medicine ER -