Endoanal ultrasonography in fecal incontinence: Current and future perspectives  

作　　者：Andreia Albuquerque 

机构地区：[1]Gastroenterology Department,CentroHospitalar Sao Joao

出　　处：《World Journal of Gastrointestinal Endoscopy》2015年第6期575-581,共7页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100%sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter.The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely,there is currently no evidence to support the use of elastography in fecal incontinence evaluation.Fecal incontinence has a profound impact in a patient＇slife, impairing quality of life and carrying a substantialeconomic burden due to health costs. It is an underdiagnosedcondition because many affected patients arereluctant to report it and also clinicians are usually notalert to it. Patient evaluation with a detailed clinicalhistory and examination is very important to indicate thetype of injury that is present. Endoanal ultrasonographyis currently the gold standard for sphincter evaluationin fecal incontinence and is a simple, well-tolerated andnon-expensive technique. Most studies revealed 100%sensitivity in identifying sphincter defect. It is betterthan endoanal magnetic resonance imaging for internalanal sphincter defects, equivalent for the diagnosisof external anal sphincter defects, but with a lowercapacity for assessment of atrophy of this sphincter.The most common cause of fecal incontinence is analsphincter injury related to obstetric trauma. Only a smallpercentage of women are diagnosed with sphinctertears immediately after vaginal delivery, but endoanalultrasonography shows that one third of these womenhave occult sphincter defects. Furthermore, in patientssubmitted to primary repair of these tears, ultrasoundrevealed a high frequency of persistent sphincter defectsafter surgery. Three-dimensional endoanal ultrasonographyis currently largely used and accepted forsphincter evaluation in fecal incontinence, improvingdiagnostic accuracy and our knowledge of physiologicand pathological sphincters alterations. Conversely,there is currently no evidence to support the use ofelastography in fecal incontinence evaluation.

关 键 词：Endoanal ultrasonography Fecal incontinence External anal sphincter Internal anal sphincter Obstetric anal sphincter injuries Three-dimensional endoanal ultrasonography ELASTOGRAPHY 

分 类 号：R473.71[医药卫生—护理学]