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Z Gastroenterol 2012; 50(12): 1281-1286
DOI: 10.1055/s-0032-1313000
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

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

Endorektaler Ultraschall (ERUS) und Real-Time-Elastografie (RTE) zur Evaluierung der analen Inkontinenz nach anorektalen Operationen
H. Allgayer
1   Department of Gastroenterology and Metabolism, Klinik Ob der Tauber, Bad Mergentheim, RehaZentren Baden Württemberg, Germany
,
A. Ignee
2   Medical Clinic 2, Caritaskrankenhaus Bad Mergentheim, Academic Teaching Hospital University of Würzburg, Germany
,
S. Zipse
1   Department of Gastroenterology and Metabolism, Klinik Ob der Tauber, Bad Mergentheim, RehaZentren Baden Württemberg, Germany
,
A. Crispin
3   Institute of Biometric Information Processing, Biometry and Epidemiology, University of Munich
,
C. F. Dietrich
2   Medical Clinic 2, Caritaskrankenhaus Bad Mergentheim, Academic Teaching Hospital University of Würzburg, Germany
› Author Affiliations
Further Information

Publication History

25 February 2012

12 June 2012

Publication Date:
07 December 2012 (online)

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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.

Zusammenfassung

Hintergrund: Die endorektale Ultraschalluntersuchung (ERUS) kombiniert mit der Real-Time-Elastografie (RTE) hat sich bei der Abklärung der analen Inkontinenz als hilfreich erwiesen. Prospektiv wurden konventionelle ERUS-Techniken mit ERUS-RTE verglichen, um prognostische Aussagen bei Patienten mit Inkontinenz nach anorektalen Operationen (mit oder ohne Bestrahlung) zu ermöglichen.

Patienten und Methoden: Prospektive monozentrische Studie, 90 Patienten mit postoperativer Stuhlinkontinenz. Zum Zeitpunkt 0, nach 3 Wochen und nach einem Jahr wurde der „Incontinence Severity Score Questionnaire“ erfragt und die rektale Manometrie, ERUS sowie quantifizierte ERUS-RTE durchgeführt.

Ergebnisse: 81 Patienten konnten zu allen Zeitpunkten adäquat beurteilt werden. Bei 24/81 (30 %) Patienten fand sich ein pathologisches Elastogramm mit vorwiegend härteren Gewebeeigenschaften. Mittels logistischer Regressionsanalyse zeigten sich keine signifikante Assoziation mit den kurz- und langfristigen Verläufen der Inkontinenz sowie keine eindeutigen Unterschiede zwischen bestrahlten und nicht bestrahlten Patienten. Konventionell endosonografisch nachweisbare Sphinkter-Defekte waren mit einer schlechteren kurz- und langfristigen Prognose assoziiert: Odds Ratio (OR)short term: 1,414 (1,107 − 1,807, p = 0,0101), ORlong term: 1,675 (95 %-KI: 1,133 − 2,477; p = 0,0294). Submukosale Verdickungen und Hypervaskularisation waren signifikant häufiger in der bestrahlten Gruppe (p < 0,01).

Diskussion: Konventionelle ERUS-Techniken erlauben prognostisch relevante Sphinkter-Defekte zu erkennen. ERUS-RTE erlaubt keine darüber hinausgehenden diagnostischen und prognostischen Aussagen.

Key words

real-time elastography - B-mode/color Doppler EUS - fecal incontinence - anorectal surgery - short-/long-term outcome - irradiation

Schlüsselwörter

Real-Time-Elastografie - endorektaler Ultraschall (ERUS) - Inkontinenz - anorektale Operation - kurz- und langfristige Prognose - Bestrahlung
 

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