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O'Connor A, Martin S, Davenport M, Klarskov N, Sharma A, McLaughlin J, Vasant DH, Kiff ES, Telford KJ. Baseline Anal Sphincter Elastance May Predict Long-Term Outcomes of Sacral Neuromodulation for Fecal Incontinence. J Surg Res 2025; 305:183-189. [PMID: 39700894 DOI: 10.1016/j.jss.2024.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 10/26/2024] [Accepted: 11/16/2024] [Indexed: 12/21/2024]
Abstract
INTRODUCTION Anal acoustic reflectometry (AAR), a novel test of anal sphincter function, was shown to predict a successful trial phase of sacral neuromodulation (SNM) for fecal incontinence. This follow-up study aims to explore if AAR can also predict short- and long-term SNM outcomes at less than and more than 5 y, respectively. METHODS Outcome data were reviewed from a prospectively managed database. Successful treatment was defined as >50% improvement in patient reported fecal incontinence or urgency episodes, or in a symptom severity score. RESULTS Twenty-six female patients (median: 53 y [range 31-80]) who received a permanent SNM implant were analyzed. In the short-term, no differences were observed in baseline AAR and symptom severity parameters between patients reporting success or failure. At long-term follow-up (median: 122 mo [113-138]) data was available from 17 (17/26, 65%) patients with 7 (7/17, 41%) reporting continued treatment success. Baseline fecal urgency episodes (P = 0.003), and the AAR parameters of opening elastance (P = 0.043) and squeeze opening elastance (P = 0.025) were significantly different between patients reporting success and those reporting failure. Squeeze opening elastance demonstrated the greatest ability to discriminate between success and failure (area under the curve: 0.82 (95% confidence interval 0.60-1.01, P = 0.003)). CONCLUSIONS AAR may have a role in identifying patients suitable for SNM treatment with clinically relevant metrics associated with successful response to treatment. Future work should explore this further to improve SNM patient selection.
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Affiliation(s)
- Alexander O'Connor
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK; Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Sarah Martin
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK
| | - Matthew Davenport
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK; Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Niels Klarskov
- Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Abhiram Sharma
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK; Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - John McLaughlin
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK; Gastroenterology Department, Salford Royal Hospital, Northern Care Alliance NHS Trust, Salford, UK
| | - Dipesh H Vasant
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK; Neurogastroenterology Unit, Gastroenterology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Edward S Kiff
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Karen J Telford
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK; Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
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O'Connor A, Byrne CM, Vasant DH, Sharma A, Liao D, Klarskov N, Kiff ES, Telford K. Current and future perspectives on the utility of provocative tests of anal sphincter function: A state-of-the-art summary. Neurogastroenterol Motil 2022:e14496. [PMID: 36377815 DOI: 10.1111/nmo.14496] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/18/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The maintenance of fecal continence depends upon coordinated interactions between the pelvic floor, anorectum, and anal sphincter complex orchestrated by central and peripheral neural activities. The current techniques to objectively measure anorectal function rely on fixed diameter catheters placed inside the anal canal with a rectal balloon to obtain measurements of anal resting and squeeze function, and rectal compliance. Until recently it had not been possible to measure the distensibility of the anal canal, or in other words its ability to resist opening against an increasing pressure, which has been proposed as the main determinant of a biological sphincter's function. Anal acoustic reflectometry (AAR) and the functional lumen imaging probe (FLIP) are two novel, provocative techniques that dynamically assess the anal sphincter complex under volume-controlled distension. In doing so, both provide information on the viscoelastic properties of the anal canal and offer new insights into its function. PURPOSE This review details the current and potential future applications of AAR and FLIP and highlights the unanswered questions relevant to these new technologies.
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Affiliation(s)
- Alexander O'Connor
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK.,Department of Colorectal Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Caroline M Byrne
- Department of Colorectal Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Dipesh H Vasant
- Neurogastroenterology Unit, Gastroenterology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, UK
| | - Abhiram Sharma
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK.,Department of Colorectal Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Donghua Liao
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Klarskov
- Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Edward S Kiff
- Department of Colorectal Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Karen Telford
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK.,Department of Colorectal Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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