J. Virjee

The detection and evaluation of locally recurrent rectal cancer with rectal endosonography

Eighty-five patients treated surgically for rectal cancer have been followed up by conventional clinical examination, sigmoidoscopy, and endosonography. Local recurrence was diagnosed in 22 patients. Nineteen of these had either sigmoidoscopic or digital evidence of recurrence and three were diagnosed solely by endosonography. In all cases endosonography gave additional information on which to base management decisions. Routine use of endosonography should allow the detection of early recurrence in a larger number of patients

The endosonic appearances of normal colon and rectum

With the increasing use of transrectal sonography, accurate preoperatives staging of rectal cancer requires correct identification of the normal ultrasonographic appearances of the colon and rectum. Fifteen rectal and colonic specimens have been studiedin vitro to define the normal anatomy. Five distinct ultrasonic layers have been identified; a first echogenic layer that corresponds to the mucosa, a second echopoor layer made up of mucosa and muscularis mucosae, a third echogenic laver that is submucosa, a fourth echopoor layer that is muscularis propria, and a fifth echogenic layer made up of serosa and perirectal fat.

An analysis of rectal morphology in obstructed defaecation

Obstructed defaecation in the descending perineum syndrome has been attributed to anterior mucosal prolapse. Manometric and radiological measurements together with evacuation proctograms in 49 patients with obstructed defaecation and normal whole gut transit times were carried out and compared in a total of 25 controls. Proctography delineated four groups: (I) puborectalis accentuation,n=11; (II) rectal intussusception,n=25; (III) anterior rectal wall prolapse,n=11; (IV) rectocele,n=2. The anorectal angle at rest, maximum basal sphincter pressures and the rectoanal inhibitory reflex did not differ between the groups and controls. Group III achieved a greater increase in anorectal angle on straining than controls. Groups II and III exhibited significant perineal descent below the pubococcygeal line whereas group I did not. In perineal descent intussusception was the commonest morphological abnormality associated with obstructed defaecation. Isolated anterior mucosal prolapse was not observed, making local treatment aimed at reducing its bulk questionable.

Endorectal sonography: laboratory and clinical experience in Bristol

The normal echographic pattern produced by the colon and rectum has been investigated in vitro. Five basic ultrasonic layers or interfaces have clearly been identified; a first echogenic layer produced by the mucosa, then an echopoor layer representing the mucosa and muscularis mucosae, an echogenic layer which was submucosa, echopoor layer which was muscularis propria and an echogenic layer which was either pararectal fat or serosa.The effectiveness of endoluminal ultrasound (ELU) in the pre-operative staging of rectal cancer has been assessed in a group of 67 patients who were also, where possible, graded by digital examination and in some cases computer aided tomography (CT) (33 patients). Digital examination had an overall accuracy of 50% and could predict invasion beyond or confinement to the rectal with an accuracy of 64%. ELU is a highly accurate method for staging local invasion and when compared to post-operative histopathology had an overall correlation coefficient of 0.88 (p< 0.001) (Rank Spearman). Our overall accuracy was 91 % and it could predict invasion beyond the muscularis propria with a sensitivity of 96%, specificity of 94% and positive predictive value of 98%.In the cohort studied by both radiological techniques ELU was more accurate than CT where overall accuracy was 79%, sensitivity was 84%, specificity was 63% and the positive predictive value was 88%.

Preoperative staging of local invasion in rectal cancer using endoluminal ultrasound.

Digital examination is the most commonly used method of assessing local invasion in rectal cancer, but it is highly subjective and accuracy is related to surgical experience. The use of transrectal ultrasound in the preoperative staging of rectal cancer has been assessed in 51 patients with histologically proven rectal cancers. Results showed a high degree of correlation when compared with postoperative histopathology (r = 0.91, P < 0.001). Invasion beyond the muscularis propria was predicted with a sensitivity of 97%. specificity of 92% and predictive value of 97%.

Fast-track barium enema: meeting the two-week wait rule for patients with suspected colorectal cancer.

Objectives  To meet the introduction of the two‐week wait (TWW) rule for patients with suspected colorectal cancer, a fast‐track barium enema (FTBE) service was set up. This study was conducted to evaluate the success of this approach in preparation for meeting the forthcoming targets on waiting times to treatment from referral and diagnosis.

Comparison of ultrasound and manometric sphincter length and incontinence scores.

AbstractPURPOSE: Fecal incontinence can be assessed by a wide variety of means that vary in their clinical relevance. This study assesses the correlation between two methods of recording sphincter length and incontinence scores. METHODS: A retrospective review of results from 1999 to 2001 of 137 patients with fecal incontinence was undertaken on patients who had both ultrasound and manometric assessment. Incontinence scores, ultrasonic sphincter length, and manometrically derived sphincter length were recorded. The data were analyzed using the Spearman rank correlation coefficient (rs) for nonparametric data. RESULTS: There was negative correlation between incontinence scores and manometric sphincter length (rs = -0.27; P = 0.002) but not with ultrasonic length (rs = -0.08; P = 0.38). There was correlation between manometric and ultrasonic lengths (rs = 0.21; P = 0.02). In males, all three correlated but none of the values were significant (n = 12). Internal and external sphincter defects had no effect on correlation coefficients. CONCLUSION: Given that all measurements include a degree of subjectivity, manometry more closely correlates with the fecal incontinence scores than ultrasound measurements. There seems to be little benefit in measuring the sphincter length with ultrasound. Manometric sphincter length measurement seems to have a role in assessing patients with fecal incontinence.