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Title: High resolution anal manometry : validation of technique and description in health and disease
Author: Gosling, J. M.
ISNI:       0000 0004 5362 2460
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2014
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The aim of this thesis was to develop and validate High Resolution Anorectal Manometry (HRAM) in order to overcome the limitations of Conventional vector volume manometry so to maximise clinical utility. A fully automated analysis method of HRAM and conventional manometry was developed and validated. HRAM was validated by demonstrating that its overall repeatability is equivalent to the current gold standard that is station pull through vector volume manometry. Normality was defined for high resolution manometry and conventional manometry. A normogram was developed for accurate interpretation of high resolution manometry during attempted balloon expulsion. Normal sphincter pressure morphology was defined using HRAM and vector volume manometry using novel display techniques. Sphincter morphology was quantified and comparison made between sexes. Using HRAM we found that constipated patients tended to increase their rectal pressure by a smaller amount than healthy volunteers. There was a poor agreement between HRAM and MR proctography in the assessment of the constipated patient. Resting pressure measured using conventional manometry was better than HRAM at distinguishing patients with passive incontinence from healthy volunteers. HRAM was marginally superior to conventional manometry in its ability to distinguish patients with urge incontinence from those with a normally functioning anorectum. In conclusion HRAM analysis was developed and the technique validated using a testretest repeatability study. Normality was defined quantitatively and qualitatively using novel display methods. Description was made of HRAM in incontinence and constipation and comparison made with conventional manometry and MR proctography.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available