| 1. |
- Aho Fält, Ursula, et al.
(författare)
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Postoperative three-dimensional endoanal ultrasound findings and relation to anal fistula plug failure
- 2023
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Ingår i: Scandinavian Journal of Gastroenterology. - 1502-7708. ; 58:10, s. 1200-1206
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo explore the utilization of three-dimensional (3D) endoanal ultrasound (EAUS) for the follow-up of the anal fistula plug (AFP), describe morphological findings in postoperative 3D EAUS, and evaluate if postoperative 3D EAUS combined with clinical symptoms can predict AFP failure.Materials and methodsA retrospective analysis of 3D EAUS examinations performed during a single-centre study of prospectively included consecutive patients treated with the AFP between May 2006 and October 2009. Postoperative assessment by clinical examination and 3D EAUS was performed at 2 weeks, 3 months and 6–12 months (“late control”). Long-term follow-up was carried out in 2017. The 3D EAUS examinations were blinded and analysed by two observers using a protocol with defined relevant findings for different follow-up time points.ResultsA total of 95 patients with a total of 151 AFP procedures were included. Long-term follow-up was completed in 90 (95%) patients. Inflammation at 3 months, gas in fistula and visible fistula at 3 months and at late control, were statistically significant 3D EAUS findings for AFP failure. The combination of gas in fistula and clinical finding of fluid discharge through the external fistula opening 3 months postoperatively was statistically significant (p
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| 2. |
- Bartosik, I, et al.
(författare)
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Vascular events are risk factors for anal incontinence in systemic sclerosis: a study of morphology and functional properties measured by anal endosonography and manometry.
- 2014
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Ingår i: Scandinavian Journal of Rheumatology. - : Informa UK Limited. - 1502-7732 .- 0300-9742. ; 43:5, s. 391-397
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To study anal sphincter morphology, anal sphincter pressure, and rectoanal inhibitory reflex (RAIR) in patients with systemic sclerosis (SSc) complicated by anal incontinence (AI) and to investigate possible risk factors for AI in SSc. Method: Nineteen SSc patients with severe AI were investigated using anal endosonography, anal manometry, and rectal manovolumetry. To determine risk factors for AI, disease characteristics of SSc patients with AI were compared with those of 95 SSc patients without AI; there were five matched SSc patients without AI for each SSc patient with AI. Results: The mean (SD) internal sphincter thickness was 1.3 (0.46) mm in patients with AI, which was thinner (p < 0.001) than reference data from healthy individuals whose internal sphincter measured 2.2 (0.45) mm, whereas the external sphincter thickness did not differ. The mean (SD) resting pressure in AI patients was lower than the reference data from healthy individuals [60 (22) vs. 94 (29) mmHg, p < 0.002] whereas the squeeze pressure did not differ. Centromeric antibodies and features of vascular disease [i.e. the presence of pulmonary arterial hypertension (PAH), digital ulcers, pitting scars, or the need for iloprost infusions] were associated with AI whereas fibrotic manifestations [i.e. modified Rodnan skin score (mRss), the diffuse cutaneous SSc (dcSSc) subset, or low vital capacity (VC)] were not. Conclusions: SSc patients with AI have a thin internal anal sphincter and a low resting pressure. Risk factors for AI among SSc patients are centromeric antibodies and vascular disease, which supports the hypothesis that gastrointestinal involvement in SSc is in part a vascular manifestation of the disease.
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| 3. |
- Sakse, A., et al.
(författare)
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Defects on endoanal ultrasound and anal incontinence after primary repair of fourth-degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle
- 2009
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 34:6, s. 693-698
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To perform three-dimensional endoanal ultrasound (EA US) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well as the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist. Methods EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth-degree ASR. AI was graded according to the Wexner score and EA US defects were graded according to the Starck score. Results Sixty-one women (73%) answered the questionnaire. The median (range) follow-up time was 5.1. (1.3-8.7) years. Thirty-three (54%) of these women underwent EAUS and were included in the study. There was no difference in the incontinence scores between women who underwent EA US and those who did not. Eleven of the women who underwent EAUS (33%) were continent, 22 women (67%) had flatus incontinence at least once a month, of whom 12 also had incontinence for liquid stool and two had incontinence for solid stool. The median Wexner score was 2 (range, 0-12). Five of the patients (15%) had no ultrasound defects. All of the patients with Wexner scores >= 4 had a Starck score of >= 10. No association between ultrasound defects and AI was demonstrated, however, the angle of the PRM and parity were associated with Starck score. No clear association between the measurements of the PRM and AI was shown. The experienced observer detected more of the small defects than did the inexperienced observer. Conclusion In a 1-9-year follow-up period after primary suture of fourth-degree ASR, the frequency of A I was high, at 67%. No clear association was seen between AI and sphincter defects detected on ultrasonography. There was an association between the angle of the PRM and the extent of ultrasound defects. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
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| 4. |
- Starck-Söndergaard, Marianne, et al.
(författare)
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Effect of vaginal delivery on endosonographic anal sphincter morphology
- 2007
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier BV. - 0301-2115. ; 130:2, s. 193-201
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe the effect of vaginal delivery with no clinically recognized sphincter tear on endosonographic anal sphincter morphology and sphincter pressure and to relate endosonographic results to anal sphincter pressure and anal incontinence score. Study design Thirty-two nullipara underwent anal endosonography and anal manometry in the third trimester of pregnancy, 2 weeks and 6 months post-partum. The sphincter defect scores (1–16) and the thickness and length of the sphincters were measured by endosonography, and sphincter pressures and manometric sphincter lengths were determined. The Wexner incontinence score (1–20) was used to classify anal incontinence 6 months post-partum. Results Five (16%) women had small endosonographic anal sphincter defects (score 3–4) before delivery. Eight women (25%; confidence interval 11–43%) had new defects detected post-partum, five small, one moderate (score 7), and two large (score 10–11). Six (75%) of eight women with new defects post-partum had undergone episiotomy versus five (21%) of 24 women with no new defects (p = 0.02). Six months after delivery 16 (50%) women reported anal incontinence, and there was a positive correlation between the endosonographic defect score 6 months post-partum and the Wexner incontinence score. The sphincter was significantly longer during pregnancy than 6 months post-partum. Conclusion New sphincter defects may arise after vaginal delivery without any clinically recognizable sphincter tear. There is a positive correlation between the endosonographic defect score 6 months post-partum and the Wexner incontinence score.
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| 5. |
- Starck-Söndergaard, Marianne, et al.
(författare)
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Endosonography of the anal sphincter in women of different ages and parity.
- 2005
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 25:2, s. 169-176
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To obtain reference data representative of normal findings at anal endosonography in pregnant and non-pregnant women. To determine intraobserver and interobserver agreement in the detection of endosonographic anal sphincter defects in asymptomatic women. Methods Twenty-five non-pregnant nulliparous women and 25 non-pregnant parous women (age range, 20-67 years) and 47 pregnant women (age range, 21-39 years) underwent anal manometry and anal endosonography. The endosonographic internal and external sphincter thickness and sphincter length were measured online. Endosonographic sphincter defects were measured and classified offline from videotapes by two independent examiners using an endosonographic defect score ranging from 0 (no defect) to 16 (maximal defect), the score taking into account the location and the longitudinal and circumferential extension of the defect. Results Endosonographic sphincter thickness and length did not differ between non-pregnant nulliparous and parous women and did not change substantially with age. The anal sphincter was thicker and the anal resting pressure area and manometric sphincter length were greater in pregnant than in non-pregnant women of the same age (20-39 years). There was good intra- and interobserver agreement with regard to detection of endosonographic anal sphincter defects (kappa 0.70). Eighteen (19%) women had endosonographic sphincter defects but in only four (4%; 4/97) cases were they moderate or large (defect score, 7-10). Ten (20%) of the non-pregnant women reported minor gas incontinence and one reported minor incontinence for both gas and liquid stool. The frequency of incontinence did not differ between women with and without sphincter defects. Conclusions Reference data representative of normal findings at anal endosonography have been established for non-pregnant women and for nulliparous women in the third trimester of pregnancy. Small endosonographic sphincter defects and minor gas incontinence are common in women without known sphincter trauma. They seem to be unrelated to each other and may be regarded as normal variants.
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| 6. |
- Starck-Söndergaard, Marianne
(författare)
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Endosonography of the anal spincter in women with particular reference to obstetric sphincter tears
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to study the endosonographic morphology of the anal sphincter in women, to establish an endosonographic sphincter defect score and to relate it to anal incontinence and anal sphincter pressure. A further aim was to determine intra-observer and inter-observer agreement in detection of endosonographic anal sphincter defects. An endosonographic anal sphincter defect classification system in women with known or unknown sphincter trauma and reference data representative of normal findings at anal endosonography in women has been established. The normal findings did not differ between nonpregnant nulliparous and parous women and did not change substantially with age. The internal sphincter was thickest at 9 o’clock, and the external sphincter was thinnest at 12 o’clock. Both endosonographic sphincter defects and minor gas incontinence were common in women without known sphincter trauma but were unrelated to each other. Small endosonographic anal sphincter defects were common (13%) in pregnant nulliparous women in the third trimester of pregnancy, and we also found new sphincter defects after vaginal delivery without a clinically recognizable sphincter tear. Episiotomy increased the risk of new defects. The larger the new defect the higher the anal incontinence score. Ninety per cent of women with a clinical third- or fourth-degree perineal tear had endosonographic sphincter defects at one week, three months and one year after primary suture. The extent of the endosonographic defects 2-7 days after primary repair, seemed to be determined mainly by the surgical experience of the doctor performing the repair and not by the clinical degree of the tear. There was a positive correlation between endosonographic sphincter defect score at one week, three months and one year and the Wexner incontinence score at one year and four years. The endosonographic sphincter score at one week was the variable most predictive of anal incontinence score at four years. This suggests that it maybe worth repairing an obstetric sphincter tear with as good an endosonographic result as possible. There was a good intra- and inter-observer agreement in detection of endosonographic anal sphincter defects.
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| 7. |
- Starck-Söndergaard, Marianne, et al.
(författare)
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Rectal endosonography can distinguish benign rectal lesions from invasive early rectal cancers.
- 2003
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 5:3, s. 50-246
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo determine whether an experienced ultrasound examiner, using good ultrasound equipment with high multifrequency probes, can discriminate between a high grade or low grade dysplastic adenoma (pT0) and very early invasive rectal cancers (pT1). Subjects and methodsSixty consecutive patients with clinically possibly pT0 or pT1 rectal tumours referred for transanal local excision underwent endorectal ultrasound examination. Lesions where the endorectal ultrasound image showed the mucosal layer to be expanded but the submucosal layer to be intact (uT0) were considered to represent a low grade or high grade dysplasia adenoma (pT0). An irregularity or disruption of the submucosal layer (uT1) was considered to characterize early invasive rectal cancers (pT1). The ultrasound staging was compared with the histological staging made on the basis of the diagnoses in the excised specimens. ResultsThe histopathological diagnoses were: invasive rectal cancer (n = 18, 10 pT1, 4 pT2, 4 pT3 cancers); high grade dysplastic adenoma (n = 21); low grade dysplastic adenoma (n = 18); non adenomatous benign lesions (n = 3). Endorectal ultrasound incorrectly classified two of the invasive cancers (both pT1 tumours) as noninvasive lesions. Five of 42 pT0 tumours were overstaged as uT1 tumours. Overstaging was more common in patients who had undergone a previous excision and in tumours with peritumoral inflammation and desmoplastic reaction. The sensitivity of endorectal ultrasound with regard to invasive cancer was 89% (16/18), specificity 88% (37/42), positive predictive value 76% (16/21), negative predictive value 95% (37/39), and accuracy 88% (53/60). Among pT0 and pT1 tumours, the corresponding figures were 80% (8/10), 88% (37/42), 62% (8/13), 95% (37/39), and 87% (45/52). ConclusionEndorectal ultrasound can distinguish between noninvasive lesions and invasive rectal cancers clinically of stage pT0 or pT1.
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| 8. |
- Starck-Söndergaard, Marianne, et al.
(författare)
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Results of endosonographic imaging of the anal sphincter 2-7 days after primary repair of third- or fourth-degree obstetric sphincter tears.
- 2003
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 22:6, s. 609-615
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To describe the endosonographic image of the anal sphincter 2-7 days after delivery in women who had undergone a primary repair of an obstetric sphincter tear. Methods Forty-eight women who had suffered a third- or fourth-degree sphincter tear at delivery and had undergone primary sphincter repair were examined with endoanal sonography 2-7 days after delivery. A score from 0 to 16 was used to describe the extent of the endosonographic defects, a score of 0 indicating no defect and a score of 16 a defect > 180° involving the whole length and depth of the sphincter. Clinical information was retrieved from the delivery and operation records after the analysis of the ultrasound images and the classification of the sonographic defects had been completed. Results Clinically, 34 (71%) women had a partial third-degree tear, 11 (23%) had a total third-degree tear, and three (6%) had a fourth-degree tear. Forty-three (90%; 95% CI, 77-97%) women had sonographic defects, all hypoechoic. Twenty-three (54%) sonographic defects were confined to the proximal part of the anal canal and involved less than half of the length of the anal canal. Thirty (63%) defects were confined to the external sphincter. Five of nine women (56%) with an endosonographic sphincter defect score 8 had undergone primary sphincter repair by a doctor in training vs. 9 of 39 women (23%) with an endosonographic sphincter score < 8 (P = 0.05), despite the fact that 86% (12/14) of the tears sutured by doctors in training were clinically partial third-degree tears vs. 65% (22/34) of those sutured by specialists (P = 0.15). Five (15%) of 34 women with a clinical partial third-degree tear had an endosonographic sphincter score 8 vs. four (29%) of 14 with a clinical total third- or fourth-degree sphincter tear (P = 0.26). Conclusions Most women (90%) with a clinical third- or fourth-degree obstetric sphincter tear have endosonographic sphincter defects if they are examined 2-7 days after primary repair. The extent of the endosonographic defects seems to be determined mainly by the surgical experience of the doctor performing the repair, and not by the clinical degree of the tear.
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| 9. |
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| 10. |
- Starck-Söndergaard, Marianne, et al.
(författare)
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The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence.
- 2006
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 27:2, s. 188-197
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe and classify endosonographic obstetric sphincter defects at 1 week, 3 months and 1 year after primary repair, and to relate the endosonographic results to anal sphincter pressure and to symptoms of anal incontinence over time. Methods Forty-one women who had suffered a third- or fourth-degree perineal tear at delivery underwent anal endosonography and anal manometry 1 week, 3 months and 1 year after primary suture of the tear. The extent of the endosonographic defects was described using defect scores ranging from 0 (no defect) to 16 (maximal defect), the score taking into account the location and the longitudinal and circumferential extent of the defect. The women answered a questionnaire with regard to bowel function 1 and 4 years after delivery, the degree of incontinence being expressed as a Wexner score. Results Some 90% (37/41) of the women had endosonographic defects at 1 week, 3 months and 1 year. The endosonographic defect scores increased significantly between the first and second examinations and then remained unchanged. At 1 year there was a negative correlation between endosonographic sphincter defect score and sphincter pressure. At 1 and 4 years, 54% (22/41) and 61% (25/41) of the women, respectively, had a Wexner score 1. There was a positive correlation between the endosonographic sphincter defect score at 1 week, 3 months and 1 year and the Wexner incontinence score at 1 and 4 years. The endosonographic sphincter defect score at 1 week was the variable that was most predictive of the Wexner score at 4 years (r = 0.48, P = 0.002). Conclusion The higher the endosonographic sphincter defect score after primary repair of an obstetric sphincter tear the lower the sphincter pressure and the higher the risk of anal incontinence.
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| 11. |
- Zawadzki, Antoni, et al.
(författare)
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A unique 3D endoanal ultrasound feature of perianal Crohn's fistula:the "Crohn ultrasound fistula sign" (CUFS).
- 2012
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910. ; 14:9, s. 608-611
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Using a high-resolution 3D endoanal ultrasound, we have observed that some perianal fistulas show a hypoechogenic fistula tract surrounded by a well-defined hyperechogenic area with a thin hypoechogenic edge outside characterized fistulas in patients with Crohn's disease ("Crohn's Ultrasound Fistula Sign" (CUFS)), unlike conventional fistula tracks.. The study aimed to determine the prevalence of CUFS in a consecutive series of patients with anal fistula. Method: 157 patients (median age 45, range 14-86 years,100 males) with perianal fistula were examined with 3D endoanal ultrasound. All 3D volumes were stored and analysed retrospectively by two independent observers blinded to the clinical information of the patients. Results: There were 29 patients with Crohn's disease of whom 20 (69%) showed CUFS,. CUFS was absent in 125 (98%) of 128 patients without Crohn's disease. The positive and negative predictive value of CUFS for Crohn's disease was 87% and 93%, respectively. The kappa value of the two independent observers was 0.77, indicating a substantial interobserver agreement. Conclusion: This study provides a new 3D endoanal ultrasound criterion, CUFS, of perianal fistula in patients with Crohn's disease. The sign can be used to discriminate a Crohn's from other types of fistula, which may be useful in the management of patients with anal fistula. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
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| 12. |
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