Anal endosonography: a survey of equipment, technique and diagnostic criteria adopted in nine Italian centers.

BACKGROUND: Anal endosonography (AES) has become an essential part of the pre-operative diagnostic workup in both organic and functional anal diseases. METHODS: Nine Italian centres with an average volume activity of >10 exams/week each were surveyed with the aim of determining the concordance with respect to indications for the procedure and interpretation of the results. RESULTS: Overall, anal sepsis, faecal incontinence and anorectal tumours were the more common indications for AES while evacuation dysfunctions and anal pain were not always considered indications. All centres use the same diagnostic criteria for simple and complicated perirectal sepsis and sphincteric defects, but adopt different classifications for stage 1 and stage 2 anal tumours. Participants agreed in that lymph-node staging by AES is less precise than tumour staging, especially after chemoradiation therapy. CONCLUSIONS: A list of recommendations and guidelines based on the groups's experience has been produced for those radiologists and coloproctologists interested in the use of AES and accreditation of their centres.

Clinical, manometric and sonographic assessment of the anal sphincters. A comparative prospective study.

One hundred patients with various anorectal disorders but intact anal sphincters were evaluated prospectively by three independent observers to determine the specificity, sensibility and accuracy of digital exploration and anal ultrasound compared to anal manometry, in assessing internal and sphincter hypertonicity (IH) and the relaxation of sphincters on straining (SR). Accuracy of the digital examination in evaluating IH was 80 vs 74%, while the SR was detected by the three observers in 82, 71 and 65% of cases. The thickness of internal sphincter increased with age (r = 0.37, P = 0.01), whereas the resting tone decreased with age (r = 0.27, P = 0.06). There was an inverse correlation between the sonographic thickness of the internal sphincter and the manometric resting tone (r = 0.29, P = 0.004). The internal sphincter thickness was 1.97 +/- 0.41 mm in constipated patients, 2.06 +/- 0.39 in the others (P = 0.03). In conclusion, IH and SR may be assessed by digital exploration with a good accuracy and the thickness of internal sphincter at ultrasound may change according to its functional state.