Ann Surg Treat Res.  2016 Feb;90(2):89-94. 10.4174/astr.2016.90.2.89.

Clinical utility of balloon expulsion test for functional defecation disorders

• Seong MK

• KMID: 2166827
• DOI: http://doi.org/10.4174/astr.2016.90.2.89

Abstract

PURPOSE
I investigated the diagnostic accuracy of balloon expulsion test (BET) with various techniques to find out the most appropriate method, and tried to confirm its clinical utility in diagnosing functional defecation disorders (FDD) in constipated patients.
METHODS
Eighty-seven patients constituted the study population. FDD was defined when patients had at least two positive findings in defecography, manometry, and electromyography. BET was done 4 times in each patient with 2 different positions and 2 different volumes. The positions were seated position (SP) and left lateral decubitus position (LDP). The volumes were fixed volume (FV) of 60 mL and individualized volume with which patient felt a constant desire to defecate (CDV). The results of BETs with 4 different settings (LDP-FV, LDP-CDV, SP-FV, and SP-CDV) were statistically compared and analyzed.
RESULTS
Of 87 patients, 23 patients (26.4%) had at least two positive findings in 3 tests and thus were diagnosed to have FDD. On receiver operating characteristic curve analysis, area under curve was highest in BET with SP-FV. With a cutoff value of 30 seconds, the specificity of BET with SP-FV was 86.0%, sensitivity was 73.9%, negative predictive value was 89.8%, positive predictive value was 65.4%, and accuracy rate was 82.8% for diagnosing FDD.
CONCLUSION
SP-FV is the most appropriate method for BET. In this setting, BET has a diagnostic accuracy sufficient to identify constipated patients who do not have FDD. Patients with negative results in BET with SP-FV may not need other onerous tests to exclude FDD.

Keyword

Balloon expulsion; Functional defecation disorders

MeSH Terms

Defecation*
Defecography
Electromyography
Humans
Manometry
ROC Curve
Sensitivity and Specificity
Statistics as Topic

Figure

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  Fig. 1 Manometric positive finding. Upper four channels are in the rectum. Lower 4 channels are in the anal canal. Their locations can be distinguished by squeeze action. In this finding, rectal pressure increased adequately, but anal pressure also increased paradoxically by push action.

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  Fig. 2 Electromyographic positive finding. It consists of dual recordings. Upper graph records activity from anal electrode. It shows paradoxical contraction. Lower graph records activity from abdominal wall electrode. It shows normal contraction which means that push action is done properly.

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  Fig. 3 Receiver operating characteristic curves of balloon expulsion tests with different techniques. Areas under curves are 0.763, 0.751, 0.846, and 0.808 in order of LDP-FV, LDP-CDV, SP-FV, and SP-CDV. LDP-FV, lateral decubitus position and fixed volume; LDP-CDV, lateral decubitus position and constant desire to defecate volume; SP-FV, seated position and fixed volume; SP-CDV, seated position and constant desire to defecate volume.

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