Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H2O2 enhancement

Yung Kim; Young Jin Park; Sridhar, Subbaramiah
October 2009
World Journal of Gastroenterology;10/14/2009, Vol. 15 Issue 38, p4810
Academic Journal
AIM: To evaluate the effectiveness of three-dimensional endoanal ultrasound (3D-EAUS) in the assessment of anal fistulae with and without H202 enhancement. METHODS: Sixty-one patients (37 males, aged 17-74 years) with anal fistulae, which were not simple low types, were evaluated by physical examination and 3D-EAUS with and without enhancement, Fistula classification was determined with each modality and compared to operative findings as the reference standard. RESULTS: The accuracy of 3D-EAUS was significantly higher than that of physical examination in detecting the primary tract (84.4% vs 68.7%, P = 0.037) and secondary extension (81.8% vs 62.1%, P = 0.01) and localizing the internal opening (84.2% vs 59.7%, P = 0.004), A contrast study with H202 detected several more fistula components including two primary suprasphincteric fistula tracks and one supralevator secondary extension, which were not detected on non-contrast study, However, there was no significant difference in accuracy between 3D-EAUS and H202enhanced 3D-EAUS with respect to classification of the primary tract (84.4% vs 89.1%, P = 0.435) or secondary extension (81.8% vs 86.4%, P = 0.435) or Iocalization of the internal opening (84.2% vs 89.5%, P = 0.406). CONCLUSION: 3D-EAUS was highly reliable in the diagnosis of an anal fistula. H202enhancement was helpful at times and selective use in difficult cases may be economical and reliable.


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