D0103 - Comparison of High-Resolution Anorectal Manometry and Magnetic Resonance Defecography in Patients With Obstructive Defecation: Are Both Tests Necessary?

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Haily Vora, MD, MPH

Mayo Clinic Florida
Jacksonville, Florida

Haily Vora, MD, MPH¹, Brian E. Lacy, MD, PhD, FACG²
¹Mayo Clinic Florida, Jacksonville, FL; ²Mayo Clinic, Jacksonville, FL

Introduction: Investigation of evacuation disorders is often pursued in patients with symptoms of obstructive defecation. High-resolution anorectal manometry (HR-ARM) is a simple, safe and widely available test to diagnose pelvic floor dysfunction. A more costly and less accessible test is magnetic resonance defecography (MRD). This study aims to qualify the added value of MRD in diagnosing pelvic floor disorders.

Methods: HR-ARM and MRD performed in patients with a diagnosis of constipation between 1/1/2020 and 5/15/22 at Mayo Clinic were identified using Epic SlicerDicer. Univariate and multivariate analyses were used to compare findings on MRD in patients with and without abnormal HR-ARM.

Results: Seventy-six consecutive patients (81.8% female, 94.8% white, age 19-82) who underwent both HR-ARM and MRD were included. The majority had evidence of dyssynergia on HR-ARM (n=49, 64.5%). Patients with dyssynergia on HR-ARM were significantly more likely to have prolonged balloon expulsion at both >60 and >30 seconds (p< 0.00001) and incomplete gel expulsion on MRD (p=0.00008) (Table 1). However, they were not more likely to have a clinically significant rectocele measuring >2cm (p=0.5093) or evidence of rectal prolapse (p=0.071). An increased number of vaginal deliveries was correlated with a higher likelihood of having a rectocele >2cm (r=0.24, p< 0.05).

Discussion: Anatomic findings on MRD were similar between patients with and without evidence of dyssynergia identified by HR-ARM. In this retrospective review, undergoing MRD in addition to HR-ARM does not appear to provide additional diagnostic information to guide therapeutic recommendations. Large prospective studies to evaluate the added value of MRD are needed.

	Dyssynergia on HR-ARM	No dyssynergia on HR-ARM	P value
	n= 49 (64.5%)	n = 27 (35.5%)
Balloon Expulsion >60 sec	30 (61.2%)	0 (0.0%)	p< 0.00001
Balloon Expulsion >30 sec	32 (65.3%)	2 (7.4%)	p< 0.00001
< 50% gel expulsion on MR	26 (53.1%)	2 (7.4%)	p=0.00008
Rectocele on MR	26 (53.1%)	22 (81.5%)	p=0.0139
>2cm Rectocele on MR	21 (42.9%)	16 (59.3%)	p=0.5093
>3cm Rectocele on MR	10 (20.4%)	9 (33.3%)	p=0.2113
>4cm Rectocele on MR	3 (6.1%)	3 (11.1%)	p=0.4413
Rectal Prolapse	5 (10%)	7 (31.8%)	p=0.071

Table: Table 1. Findings on MRD and balloon expulsion test in patients with and without dyssynergia on HR-ARM

Disclosures:

Haily Vora indicated no relevant financial relationships.

Brian Lacy: Allakos – Advisory Committee/Board Member. Allergan Pharmaceuticals – Advisory Committee/Board Member. Arena Pharmaceuticals, Inc. – Advisory Committee/Board Member. Cosmos – Advisory Committee/Board Member. Ironwood Pharmaceuticals, Inc. – Advisory Committee/Board Member. Salix Pharmaceuticals, Inc. – Advisory Committee/Board Member. Viver Health – Consultant.

Haily Vora, MD, MPH¹, Brian E. Lacy, MD, PhD, FACG². D0103 - Comparison of High-Resolution Anorectal Manometry and Magnetic Resonance Defecography in Patients With Obstructive Defecation: Are Both Tests Necessary?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.