SYSTEMATIC REVIEW WITH META-ANALYSIS
Systematic review with meta-analysis: defecography should be a first-line diagnostic modality in patients with refractory constipation
Ugo Grossi,
Gian Luca Di Tanna,
Henriette Heinrich,
Stuart A. Taylor,
Charles H. Knowles,
S. Mark Scott,
Corresponding Author
Ugo Grossi
Centre for Trauma and Surgery, and GI Physiology Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Correspondence
Dr. Ugo Grossi, Centre for Trauma and Surgery, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Email: [email protected]
Search for more papers by this authorGian Luca Di Tanna
Department of Econometrics, Statistics and Applied Economics, Riskcenter – IREA, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorHenriette Heinrich
Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorStuart A. Taylor
Centre for Medical Imaging, University College London, London, UK
Search for more papers by this authorCharles H. Knowles
Centre for Trauma and Surgery, and GI Physiology Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Search for more papers by this authorS. Mark Scott
Centre for Trauma and Surgery, and GI Physiology Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Search for more papers by this authorUgo Grossi,
Gian Luca Di Tanna,
Henriette Heinrich,
Stuart A. Taylor,
Charles H. Knowles,
S. Mark Scott,
Corresponding Author
Ugo Grossi
Centre for Trauma and Surgery, and GI Physiology Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Correspondence
Dr. Ugo Grossi, Centre for Trauma and Surgery, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Email: [email protected]
Search for more papers by this authorGian Luca Di Tanna
Department of Econometrics, Statistics and Applied Economics, Riskcenter – IREA, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorHenriette Heinrich
Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorStuart A. Taylor
Centre for Medical Imaging, University College London, London, UK
Search for more papers by this authorCharles H. Knowles
Centre for Trauma and Surgery, and GI Physiology Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Search for more papers by this authorS. Mark Scott
Centre for Trauma and Surgery, and GI Physiology Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Search for more papers by this authorAs part of AP&T's peer-review process, a technical check of this meta-analysis was performed by Dr Y Yuan. The Handling Editor for this article was Dr Colin Howden, and it was accepted for publication after full peer-review.
Summary
Background
Defecography is considered the reference standard for the assessment of pelvic floor anatomy and function in patients with a refractory evacuation disorder. However, the overlap of radiologically significant findings seen in patients with chronic constipation (CC) and healthy volunteers is poorly defined.
Aim
To systematically review rates of structural and functional abnormalities diagnosed by barium defecography and/or magnetic resonance imaging defecography (MRID) in patients with symptoms of CC and in healthy volunteers.
Methods
Electronic searches of major databases were performed without date restrictions.
Results
From a total of 1760 records identified, 175 full-text articles were assessed for eligibility. 63 studies were included providing data on outcomes of 7519 barium defecographies and 668 MRIDs in patients with CC, and 225 barium defecographies and 50 MRIDs in healthy volunteers. Pathological high-grade (Oxford III and IV) intussuscepta and large (>4 cm) rectoceles were diagnosed in 23.7% (95% CI: 16.8-31.4) and 15.9% (10.4-22.2) of patients, respectively. Enterocele and perineal descent were observed in 16.8% (12.7-21.4) and 44.4% (36.2-52.7) of patients, respectively. Barium defecography detected more intussuscepta than MRID (OR: 1.52 [1.12-2.14]; P = 0.009]). Normative data for both barium defecography and MRID structural and functional parameters were limited, particularly for MRID (only one eligible study).
Conclusions
Pathological structural abnormalities, as well as functional abnormalities, are common in patients with chronic constipation. Since structural abnormalities cannot be evaluated using nonimaging test modalities (balloon expulsion and anorectal manometry), defecography should be considered the first-line diagnostic test if resources allow.
Supporting Information
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