PWE-58 Are novel and established anorectal physiology diagnostics associated with symptoms and quality-of-life in faecal incontinence?

Abstract

<h3>Introduction</h3> High-resolution anorectal manometry (HRAM) is an established assessment modality. Novel techniques, such as the Functional lumen imaging probe (EndoFLIP) and Anal Acoustic Reflectometry (AAR) are currently predominantly considered research tools. However, there is recognised, and well-documented, discordance between HRAM parameters, symptom severity and quality-of-life scores (QoL) in patients with faecal incontinence (FI). The aim of this study was to examine metrics from each of these three modalities and investigate whether they correlated with patients’ symptoms and QoL. <h3>Methods</h3> Females with FI undergoing HRAM at a tertiary pelvic floor centre were recruited and completed a series of symptom questionnaires including Vaizey FI score (VFI), Constipation Scoring System (CSS), and the Manchester Health QoL (MHQ). Following HRAM, patients had AAR and FLIP subsequently in a randomised order. Resting and squeeze parameters were recorded (Opening/Squeeze opening pressure (Op/SqOp) for AAR, distensibility index (DI) for EndoFLIP and resting/incremental squeeze pressure for HRAM). Correlations between symptom scores and QoL measures were compared with anorectal physiology metrics using Spearman’s correlation. <h3>Results</h3> Twenty females [median age 61.5 years (IQR 51.5-66yrs)] with FI (mixed 45%, passive 35%, urge 20%) were recruited. There was no difference in median VFI (p=0.293), CSS (p=0.473) or MHQ (p=0.490) scores between FI sub-type. Those with a low resting and incremental squeeze pressures (HRAM) had a higher Vaizey score and reported a poorer QoL (coefficient -0.46, p=0.046 and -0.58, p=0.09 respectively). The higher the DI during squeeze and lower the squeeze opening pressure, the higher the Vaizey score (coefficient 0.51, p=0.028 and -0.49 and p=0.034 respectively) (Table 1). <h3>Conclusions</h3> This novel study comparing metrics from three anorectal physiology modalities has demonstrated that each technique had at least one parameter (resting or squeeze) that correlated with either symptom severity and QoL in patients with FI, supporting the need for further research on the utility of EndoFLIP and AAR.