Comparison of MRI and Endoanal Ultrasound in Assessing Intersphincteric, Transsphincteric, and Suprasphincteric Perianal Fistula.

OBJECTIVES: Perianal fistula is a common disorder characterized by an anomalous perianal track connecting two epithelialized surfaces, most commonly the anal canal and the perianal skin. Although each has its limitations, magnetic resonance imaging (MRI) and endoanal ultrasound are currently two acceptable modalities for assessing perianal fistula. This study aimed to evaluate the accuracy of MRI and endoanal ultrasonography in diagosing perianal fistula, considering the surgical results as the references. METHODS: This prospective cohort study was performed on patients with symptomatic perianal fistulas. MRI results of patients reported by the radiologist were collected along with the findings of endoanal ultrasonography performed by a gastroenterologist. These results were compared with surgical findings as the reference standard. RESULTS: The study enrolled 126 patients. Exactly 222 definitive fistulas were identified during surgery. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound for perianal fistula were 87.38, 38.46, 92.38, 26.31, and 82.25% respectively; and for MRI were 76.12, 57.69, 93.88, 22.05, and 74.19% respectively. The accuracy of endoanal ultrasound for detecting transsphincteric and intersphincteric fistulas was higher than MRI. In contrast, the diagnostic value of MRI for detecting suprasphincteric fistulas was higher than endoanal ultrasound. CONCLUSIONS: Using endoanal ultrasonography to diagnose perianal fistulas is a relatively accurate method. This method may be more sensitive than MRI in detecting patients with perianal fistulas and abscesses.

Evaluation of diagnostic accuracy of 3-D endoanal ultrasound in perianal fistula in comparison with intraoperative findings / Avaliação da precisão diagnóstica da USE 3D endoanal em casos de fistula perianal, em comparação com os achados cirúrgicos

ABSTRACT Objective: Perianal fistula is a common and debilitating disease. The definite treatment is surgery, identifying of primary and secondary tract, internal opening of fistula has important role in planning of surgical techniques. This study's goal was to determine the diagnostic accuracy of 3-D ultrasound in perianal fistula in comparison with intraoperative findings. Materials and methods: This study is a cross-sectional study. Adult patients (18-85 years old) with anal fistula have been selected. 3-D EUS was done for all patients by gastroenterologist. Then surgery was done. Check lists filled by endoscopist and surgeon was studied and data analysis was done. Results: The study examined 76 patients, in according to results for kappa coefficient there was a perfect agreement between 3-D ultrasound results and surgery in internal opening that was 96% (p < 0.001) and concordance was 0.974. In extension tract the agreement was 0.973 and concordance was 0.987 (p < 0.001). Conclusion: There was perfect agreement between 3-D ultrasound and surgical findings in internal opening, primary tract and trunk expansion. 3-D ultrasound shows a high diagnostic accuracy when compared with surgery to assessment of perianal fistula before surgery.

RESUMO Objetivo: A fistula perianal é doença comum e debilitante. O tratamento definitivo é cirúrgico. A identificação dos tratos primário e secundário e de abertura interna da fístula desempenha papel importante no planejamento das técnicas cirúrgicas. O objetivo do presente estudo foi determinar a precisão diagnóstica da USE 3D em casos de fístula perianal, em comparação com os achados cirúrgicos. Materiais e métodos: Este é um estudo transversal. Foram selecionados pacientes adultos (18-85 anos) com fístula anal. Todos os pacientes foram examinados por USE 3D realizada por um gastroenterologista. Em seguida, procedeu-se à cirurgia. O endoscopista e o cirurgião estudaram as listas de verificação, com análise dos dados. Resultados: Nesse estudo foram examinados 76 pacientes. De acordo com os resultados para o coeficiente kappa, foi observada perfeita concordância entre os resultados da USE 3D e cirurgia para IO, de 96% (p < 0,001), com concordância de 0,974. Na extensão do trato a concordância foi 0,973 e concordância de 0,987 (p < 0,001). Conclusão: Foi observada concordância perfeita entre USE 3D e os achados cirúrgicos em abertura interna, trato primário e expansão do tronco. USE 3D demonstra elevada precisão diagnóstica, quando comparada com a cirurgia, para avaliação da fístula perianal antes da operação.

The high frequency of esophageal disorders in Iranian patients with non-cardiac chest pain.

AIM: The aim of this study was to evaluate the prevalence of gastrointestinal disorders in non-cardiac chest pain (NCCP) Iranian patients. BACKGROUND: Gastro-esophageal reflux disease (GERD) is the most common cause of NCCP, which accounts for about one third of cases. METHODS: This was a descriptive study on consecutive NCCP patients who referred to the gastroenterology clinic at the Taleghani Hospital, Tehran, Iran from 2015 to 2017. Medical history, physical examination and esophageal test including upper gastroenterology (UGI) endoscopy, esophageal manometry and 24 hour ambulatory esophageal pH monitoring were done for each participant. RESULTS: The study included 102 patients, of which 58.9% were women, and the mean age of patients was 41.5 ± 11.2 years. The most common symptoms associated with chest pain were regurgitation in 28.4%, dysphagia in 23.5% and heartburn in 19.6% patients. UGI endoscopy was abnormal in 29.4% cases, esophageal manometry was abnormal in 61.7% cases and ambulatory pH monitoring was abnormal in 37.2% patients. Using UGI endoscopy and combined 24-h pH monitoring determined the prevalence of GERD 44.1% , and based on manometry the most frequent causes of NCCP was ineffective esophageal motility (IEM) in 19.6% patients with NCCP. CONCLUSION: Detecting etiology of NCCP allows healthcare providers to assure patients of the benign nature of their condition and provide appropriate treatment. It can also help prevent excessive hospital and physician visits as well as the costly and potentially risky testing which often results.

The evaluation of functional results before and after laparoscopic Heller myotomy for achalasia: a single center experience.

AIM: The aim of this study was to evaluate and compare the functional results before and after laparoscopic Heller myotomy for Iranian patients with achalasia. BACKGROUND: Achalasia is a severe neuromuscular disorder of the esophagus, characterized by the loss of peristalsis and an inability of the lower esophageal sphincter (LES) to reach optimal relaxation. METHODS: In this cross sectional study, patients who underwent Heller myotomy for achalasia via laparoscopy in Taleghani Hospital Tehran, Iran were evaluated. Symptoms including pressure of residual, integrated relaxation sphincter (IRP), pressure of free drinking, pressure of LES, dysphasia score and peristalsis movement was measured and recorded by manometry before and after (2 months) treating with Heller myotomy. RESULTS: In this study, 23 patients with achalasia (12 females and 11 males) with a mean age of 30±3.5 years (minimum 20, maximum 44 years) who met the inclusion criteria of the study were examined. Results of this study showed that, all the diagnostic criteria that were measured before the treatment was significantly different from after the treatment (P<0.05). The average decline in LES, IRP, Residual Pressure, Free drinking esophagus, and dysphasia score were 23.1 mmHg, 16.24 mmHg, 18,7 mmHg, 18.9 mmHg, and 5.0 unit, respectively. Also the average increase of the peristalsis movement was 8.26±13.7 in 8 patients. CONCLUSION: Considering the results of Heller myotomy surgery can be as a treatment of choice for achalasia. Free Drinking pressure can be a suitable criteria after treatment for evaluation and prediction of the reducing the dysphasia score after the surgery.

Effect of general anesthesia during GI endoscopic procedures on patient satisfaction.

AIM: To compare the conventional GI endoscopy and using general anesthesia during the procedure regarding the satisfaction and acceptance among Iranian patients. BACKGROUND: Ability to measure and assess the patients' satisfaction with colonoscopy and upper endoscopy will improve the quality of health care provided by gastroenterologists and thus resulting in better acceptability of endoscopy. PATIENTS AND METHODS: In a prospective, multicenter, non-randomized clinical trial 756 patients were included between 2009 and 2010. A satisfaction developed questionnaire was answered by the patients who were candidate for elective upper and/or lower GI endoscopy within 72 hours after the procedure. Total satisfaction score was measured and compared between endoscopy patients with and without anesthesia. Different variables analyzed in order to find the influencing factors in patient satisfaction during the endoscopic procedures. RESULTS: The mean age of patients was 40.7 ± 15.1 years and 59% of them were female. Overall, 50.5% of patients underwent general anesthesia during the endoscopic procedure. There was a significant correlation between education level and satisfaction with the endoscopy. Also, anesthesia during endoscopy significantly increased the total satisfaction score of the patients (OR= 2.07, 95% CI: 1.24-2.9, P < 0.0001). CONCLUSION: The level of patient's education and using anesthesia during GI endoscopy were two factors influencing the total patient satisfaction with the endoscopic procedures. Thus, we suggest using anesthesia for GI endoscopic procedures.

Evaluation of patients' satisfaction with anesthesia in gastrointestinal endoscopic procedures in Iran.

AIM: The purpose of this study was to assess satisfaction level and related factors among patients who had an anesthesia during endoscopic procedures; and also validate a questionnaire for evaluating satisfaction with anesthesia. BACKGROUND: The level of patient satisfaction with GI endoscopic procedure is an important criterion to indicate the level of expertise in endoscopy. PATIENTS AND METHODS: We performed a prospective descriptive study at Resalat Hospital, Tehran, Iran. Three hundred seventy nine elective patients undergoing anesthesia for GI endoscopy procedure in 2010 were recruited. A 20-item questionnaire was used to evaluate the satisfaction with the anesthesia. The questionnaire was answered within 72 hours after the procedure. The satisfaction was graded into four major groups: anesthesia delivery, procedural recall, side effects and global satisfaction. RESULTS: The level of satisfaction with anesthesia and its related factors were determined. The mean score of satisfaction with anesthesia delivery, procedural recall, side effects, global satisfaction, and total satisfaction (question 1-16) were 6.15 ± 1.23, 5.65± 1.48, 5.24± 1.16, 5.01± 1.29, and 5.46± 1.14, respectively. There was a significant difference in patients' satisfaction level between different jobs (p=0.02) as well as different levels of education (p=0.01). CONCLUSION: Higher educational level was accompanied with greater satisfaction. The highest satisfaction score was seen among retired patients and the lowest level was found in housekeepers.

Non-erosive reflux disease compared with erosive esophagitis with regards to acid reflux and symptom patterns.

BACKGROUND/AIMS: Non-erosive reflux disease and erosive esophagitis are the most common phenotypic presentations of gastroesophageal reflux disease. Recent reports suggest that patients with non-erosive reflux disease treated with antireflux medications show lower symptom improvement rates than patients with erosive esophagitis treated with the same medications. The aim was to assess the acid reflux and symptom patterns of patients with non-erosive reflux disease in comparison with those with erosive esophagitis and to identify different non-erosive reflux disease subgroups. MATERIAL AND METHODS: One hundred and twenty consecutive patients (67 male, age: 37.6±12.9 years) seen for classic heartburn symptoms were evaluated for the study. The patients underwent upper endoscopy and 24-hour ambulatory pH monitoring. RESULTS: Erosive esophagitis was identified in 51 patients and nonerosive reflux disease in 69 patients. According to pH metric findings (DeMeester Score >14.72 or Fraction Time >4%), 31.9% of the non-erosive reflux disease group and 47.1% of the erosive gastroesophageal reflux disease group had abnormal acid reflux (p=0.134). Erosive esophagitis patients showed a similar pattern of acid reflux to non-erosive reflux disease patients in the different positions (supine and upright). Non-erosive reflux disease-negative (normal pH test) patients demonstrated a significantly lower degree of esophageal acid exposure when compared with those with erosive esophagitis. About 10.6% of the non-erosive reflux disease-negative patients and 45.5% of the non-erosive reflux disease-positive (abnormal pH test) patients had a positive symptom index (≥50%) during the distal pH metry (p=0.003). CONCLUSIONS: Acid reflux characteristics and symptom patterns suggest that the non-erosive reflux disease group represents a heterogeneous group of patients.