PLANIMETRIC IMPEDANCEOMETRY IN ASSESSMENT OF THE FUNCTIONAL STATE OF ANAL SPHINCATORS

The article gives an overview of publications on the use of impedance planimetric method in the study of anorectal function. Anal sphincters normally respond reflexively to the stretching of the rectum by intestinal contents that fill and stretch the rectum. The idea of the method lies in the fact that is artificial stretching of the anal canal with simultaneous recording of pressure and building a virtual geometric shape directly in response to the tension, and calculates a coefficient of elasticity of the anal canal that quantitatively characterize the response of the anal sphincter in tension. For the first time in Russia, it became possible to use this method in coloproctological patients in the State Scietific Centre of Coloproctology. In the article step by step assessed the main uses of the techniques described in the literature: the description of the method and normative values, then - comparison of extensibility of anal sphincters at rest and with voluntary reduction in norm in volunteers and patients with anal incontinence, including patients with scleroderma, then compared the results of this technique with high-resolution 3D manometry. In addition, the use of the Endoflip method as a dynamic control of the treatment of anal sphincter failure by means of sacral stimulation is analyzed.

impedance planimetric technique, anal sphincter deficiency, pelvic floor muscles, high resolution anorectal manometry, elasticity, extensibility, intraluminal imaging probe EndoFLIP

1. Шелыгин Ю. А., редактор. Колопроктология/Клинические рекомендации. М.: ГЭОТАР-Медиа; 2015. С. 190-213.

2. Johanson J. F., Lafferty J. Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol. 1996; 91: 33-6.

3. Фролов С.А., Титов А. Ю., Костарев И. В., Полетов Н. Н., Джанаев Ю. А. Тибиальная нейромодуляция в лечении больных с различными формами недостаточности анального сфинктера. Колопроктология. 2013; 2(44): 37-43.

4. Whitehead W. E., Borrud L., Goode P. S. et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009; 137: 512-7.

5. Bharucha A. E. Pelvic floor: anatomy and function. Neurogastroenterol Motil. 2006; 18: 507-19.

6. Sangwan Y. P., Solla J. A. Internal anal sphincter: advances and insights. Dis Colon Rectum. 1998; 41: 1297-311.

7. Rasmussen O. O., Christiansen J. Physiology and pathophysiology of anal function. Scand J Gastroenterol. Suppl. 1996; 216: 169-74.

8. Delancey J. O., Toglia M. R., Perucchini D. Internal and external anal sphincter anatomy as it relates to midline obstetric lacerations. Obstet Gynecol. 1997; 90: 924-7.

9. Bharucha A. E. Anorectal manometry and imaging are necessary in patients with fecal incontinence. Am J Gastroenterol. 2006; 101: 2679-81.

10. Azpiroz F., Enck P., Whitehead W. E. Anorectal functional testing: review of collective experience. Am J Gastroenterol. 2002; 97: 232-40.

11. Rao S.S., Hatfield R., Soffer E., Rao S., Beaty J., Conklin J. L. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol. 1999; 94: 773-83.

12. Eckardt V. F., Kanzler G. How reliable is digital examination for the evaluation of anal sphincter tone? Int J Colorectal Dis. 1993; 8: 95-7.

13. Harris L. D., Winans C. S., Pope C. E. 2nd. Determination of yield pressures: a method for measuring anal sphincter competence. Gastroenterology. 1966; 50: 754-60.

14. Kwiatek M. A., Kahrilas P. J., Soper N. J. et al. Esophagogastric junction distensibility after fundoplication assessed with a novel functional luminal imaging probe. J Gastrointest Surg. 2010; 14: 268-76.

15. Gregersen H., Drewes А. Functional oesophago-gastric junction imaging. World J Gastroenterol. 2006 May 14; 12(18): 2818-2824. www.wjgnet.com World Journal of Gastroenterology ISSN1007-9327

16. McMahon B., Frøkjær J., Kunwald Р., Liao D., Funch-Jensen Р., Drewes А. et al. The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction. Am J Physiol Gastrointest Liver Physiol 292: G377-G384, 2007. First published August 31, 2006; doi:10.1152/ajpgi.00311.2006.

17. Alqudah M. M., Gregersen H., Drewes A. M., McMahon B. P. Evaluation of anal sphincter resistance and distensibility in healthy controls using EndoFLIP Neurogastroenterol Motil. 2012 Dec; 24(12): 591-9.

18. Alqudah М., Whelan М., McNamara D., Neary Р., McMahon В. EndoFLIP® to Measure Anal Sphincters Distensibility in Healthy and Faecal Incontinence Gastroenterology. 2014; 146, Issue 5: 715

19. Luft F., Fynne L., Gregersen H., Lundager F., Buntzen S, Lundby L. et al. Functional luminal imaging probe: a new technique for dynamic evaluation of mechanical properties of the anal canal. Tech Coloproctol. 2012 Aug 31; 16(6): 451-7.

20. Fynne L., Luft F., Gregersen H., Buntzen S., Lundby L., Lundager F. Distensibility of the anal canal in patients with systemic sclerosis: A study with the Functional Lumen Imaging Probe. Colorectal Dis. 2012 Oct 16. doi: 10.1111/codi.12063.

21. Gourcerol G., Granier S., Bridoux V., Menard J. F., Ducrotté P., Leroi A. M. Do endoflip assessments of anal sphincter distensibility provide more information on patients with fecal incontinence than high-resolution anal manometry? Neurogastroenterol Motil. 2015 Dec 15. doi: 10.1111/nmo.12740.

22. Haas S., Liao D., Gregersen H., Lundby L., Laurberg S., Krogh K. Increased yield pressure in the anal canal during sacral nerve stimulation: a pilot study with the functional lumen imaging probe. Neurogastroenterol Motil. 2016 Aug 21; 15: 25-31.

23. Sorensen G., Liao D., Lundby L., Fynne L., Buntzen S., Gregersen H. et al. Distensibility of the anal canal in patients with idiopathic fecal incontinence: a study with the Functional Lumen Imaging Probe Neurogastroenterol Motil. 2014; 26: 255-263.

24. Liu J., Guaderrama N., Nager C. W., Pretorius D. H., Master S., Mittal R. K. Functional correlates of anal canal anatomy: puborectalismuscle and anal canal pressure. Am J Gastroenterol. 2006; 101: 1092-1097.