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(Radiology. 1999;211:223-227.)
© RSNA, 1999

Gastrointestinal Imaging

Evacuation Proctography: A Prospective Study of Diagnostic and Therapeutic Effects1

Christopher J. Harvey, MRCP, Steve Halligan, MD, MRCP, FRCR, Clive I. Bartram, FRCR, FRCP, Nicholas Hollings, MRCP, Anjou Sahdev, MRCP and Kate Kingston, MRCP

1 From the Intestinal Imaging Centre, St Mark's Hospital, Northwick Park, Watford Rd, Harrow, England HA1 3UJ. Received March 5, 1998; revision requested May 6; revision received June 24; accepted October 20. S.H. was supported in part by the St Mark's Research Foundation. Address reprint requests to S.H.

PURPOSE: To determine the diagnostic and therapeutic effects of evacuation proctography.

MATERIALS AND METHODS: Forty-seven referring clinicians completed pre–evacuation proctography questionnaires for 50 patients, detailing diagnoses, confidence in these, intended management, and what they hoped to learn. After evacuation proctography, the radiology report was returned with a second questionnaire asking the diagnosis in the light of evacuation proctographic findings, their confidence, and what they had learned. Clinicians quantified management contribution and indicated how useful they found evacuation proctography in general. Results from pre– and post–evacuation proctography questionnaires were compared to determine the diagnostic and therapeutic effects.

RESULTS: Diagnostic confidence rose significantly after evacuation proctography (mean, 7.0 before evacuation proctography vs 8.4 after evacuation proctography; P < .001). Lead diagnosis changed in nine (18%) patients. Intended surgical management became nonsurgical after evacuation proctography in seven (14%) patients, and intended nonsurgical therapy became surgical in two (4%). Surgery remained likely in 15 patients, but its nature changed in five (10%). Five (10%) clinicians stated that evacuation proctographic findings resolved diagnostic conflict, and nine (18%) found that evacuation proctographic findings revealed unsuspected diagnoses. Clinicians found evacuation proctography of major benefit in 20 (40%) cases studied and of moderate benefit in 20 (40%). In general, 20 (43%) clinicians found evacuation proctography very useful and 24 (51%) found it moderately useful.

CONCLUSION: Evacuation proctography has a substantial diagnostic and therapeutic effect and is of considerable benefit to referring clinicians.

Index terms: Defecography, 757.1288 • Rectum, abnormalities, 757.1288, 757.73, 757.79 • Rectum, radiography, 757.1288




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