Empfehlungen zur Anorektalen Manometrie im Erwachsenenalter

C. Pehl; P. Enck; A. Franke; T. Frieling; W. Heitland; A. Herold; H. Hinninghofen; M. Karaus; J. Keller; H.-J. Krammer; M. Kreis; R. Kuhlbusch-Zicklam; H. Mönnikes; U. Münnich; T. Schiedeck; M. Schmidtmann

doi:10.1055/s-2007-963099

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2007; 45(5): 397-417
DOI: 10.1055/s-2007-963099

Leitlinien

Empfehlungen zur Anorektalen Manometrie im Erwachsenenalter[1]

Anorectal Manometry[2] C. Pehl¹ , P. Enck² , A. Franke³ , T. Frieling⁴ , W. Heitland⁵ , A. Herold⁶ , H. Hinninghofen⁷ , M. Karaus⁸ , J. Keller⁹ , H.-J Krammer¹⁰ , M. Kreis¹¹ , R. Kuhlbusch-Zicklam⁴ , H. Mönnikes¹² , U. Münnich¹³ , T. Schiedeck¹⁴ , M. Schmidtmann¹²

¹Medizinische Klinik, Kreiskrankenhaus Vilsbiburg
²Klinik für Innere Medizin VI - Psychosomatik, Universitätsklinikum Tübingen
³II. Med. Klinik, Universitätsklinikum Mannheim
⁴Medizin. Klinik II, Klinikum Krefeld
⁵Chirurgische Klinik, Klinikum München-Bogenhausen
⁶Enddarmzentrum Mannheim
⁷Klinik für Innere Medizin VI, Psychosomatik, Universitätsklinikum Tübingen
⁸Medizinische Klinik, Evangelisches Krankenhaus, Göttingen
⁹Klinik für Innere Medizin, Israelitisches Krankenhaus, Hamburg
¹⁰Praxis für Gastroenterologie und Ernährungsmedizin, Mannheim
¹¹Chirurgische Klinik, Ludwig-Maximilians-Universität (Klinikum Großhadern) München
¹²Medizinische Klinik m.S. Hepatologie & Gastroenterologie, Universitätsklinikum Charité, Campus Virchow-Klinikum, Berlin
¹³Medtronic GmbH, Düsseldorf/Halle
¹⁴Klinik für Allgemein- und Viszeralchirurgie, Klinikum Ludwigsburg

Abstract

Zusammenfassung

Die Gesellschaft für Neurogastroenterologie hat in Zusammenarbeit mit den Deutschen Gesellschaften für Verdauungs- und Stoffwechselkrankheiten (Kommission Proktologie), für Viszeralchirurgie (Arbeitsgruppe Colo-Proktologie) und für Koloproktologie Empfehlungen zur anorektalen Manometrie beim Erwachsenen erarbeitet. Die Empfehlungen umfassen die Abschnitte „Technische Grundlagen”, „Vor- und Nachbereitung”, „Durchführung und Auswertung”, „Reproduzierbarkeit” sowie „Indikationen”. Bei jeder anorektalen Manometrie sind als Mindestanforderung zu bestimmen: der Ruhe- und maximale Kneifdruck im Analkanal, das Vorhandensein respektive Fehlen des rektoanalen Inhibitionsreflexes, die sensorischen Schwellenwerte für Rektumdehnung (Perzeptions- und Stuhldrangschwelle) sowie eine Compliancemessung des Rektums bei einer Ballonfüllung mit 100 mL. In Abhängigkeit von spezifischen Fragestellungen oder laborspezifischen Protokollen kann zusätzlich die Analkanallänge, die Dauerkontraktionsleistung, die Schmerzschwelle bei Rektumdehnung bestimmt sowie ein Husten- oder Defäkationstest durchgeführt werden. Die Durchführung einer anorektalen Manometrie ist im Rahmen eines strukturierten Programms zur Abklärung der Stuhlinkontinenz und Obstipation indiziert. Weiter kann eine anorektale Manometrie im Einzelfall präoperativ, vor Biofeedback-Therapie sowie bei Patienten mit idiopathischem Schmerzsyndrom oder Reizdarm sinnvoll sein.

Abstract

This document contains the guidelines of the German Societies of Neurogastroenterology and Motility, Gastroenterology (committee for proctology), Abdominal Surgery (coloproctology working group), and Coloproctology for anorectal manometry in adults. Recommendations are given about technical notes, study preparation (equipment; patient), technique for performing manometry and data analysis, reproducibility, and indications. Minimum standards for anorectal manometry are measurement of resting and squeeze pressure, testing of rectoanal inhibitory reflex, determination of rectal sensation (first perception and urge), and calculation of rectal compliance. Anorectal manometry is indicated in patients with fecal incontinence and constipation in the context of a structured programme.

Schlüsselwörter

Darm - Rektummanometrie - Empfehlungen

Key words

intestine - rectal manometry - recommendations

Full Text

References

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1 Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität, der Kommission Proktologie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, der Deutschen Gesellschaft für Koloproktologie und der Chirurgischen Arbeitsgruppe Colo-Proktologie der Deutschen Gesellschaft für Viszeralchirurgie zur anorektalen Manometrie im Erwachsenenalter

2 Recommendations of the German Society for Neurogastroenterology and Motility, The Commission Proctology of the German Society for Digestive and Metabolic Diseases, the German Society for Coloprotology and the Surgical Working Group Coloproctology of the German Society for Visceral Surgery on Anorectal Manometry in Adults

Dr. Christian Pehl

Medizinische Klinik, Kreiskrankenhaus Vilsbiburg

Krankenhausstr. 2

84137 Vilsbiburg

Phone: ++49/87 41/60 31 53

Fax: ++49/87 41/60 32 04

Email: christian.pehl@kkh-vilsbiburg.de