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Intra- and inter-observer agreement in the classification of dyssynergic defecation on high-resolution anorectal manometry using water-perfusion system

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background and Aims

Dyssynergic defecation (DD) classified on anorectal manometry is based on variations in anal sphincter pressures and rectal pressure generated during bearing down. There is a paucity of data on intra- and inter-observer agreement in the classification of DD on high-resolution anorectal manometry (HRAM) using a water-perfusion system.

Methods

This cross-sectional observational study was conducted between June 2014 and May 2016 on 70 adult patients with DD. Observer 1 did the baseline analysis and reanalyzed the readings at least 6 months later, blinded to the initial analysis results (intra-observer variability). Four other blinded observers (5–25 years in anorectal manometry and minimum 5 years of experience in HRAM) then individually analyzed the manometry data (inter-observer variability).

Results

Intra-observer agreement was excellent (kappa 0.862) for classifying DD. Agreement between the six observations (i.e. two from observer 1 and four from independent observers) was also good (kappa 0.632). The highest agreement was for type 4 DD (kappa 0.738), followed by type 1 (0.680), type 2 (0.664), and type 3 (0.537). Cronbach’s alpha value was 0.93, suggesting excellent internal consistency.

Conclusion

The diagnosis of the types of DD on anorectal manometry using a water-perfusion system has excellent intra-observer and good inter-observer agreement .

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Authors and Affiliations

  1. Department of Gastroenterology, Seth G S Medical College and K E M Hospital, New Building, 11th floor, Parel, Mumbai, 400 012, India

    Dhiraj Agrawal, Megha Meshram, Harish Darak, Abhishek Sadalage, Deepak Gupta, Shobna Bhatia & Akash Shukla

  2. Department of Gastroenterology, P D Hinduja Memorial Hospital, Mumbai, 400 016, India

    Philip Abraham

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  1. Dhiraj Agrawal
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  2. Megha Meshram
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  3. Harish Darak
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  5. Deepak Gupta
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  6. Philip Abraham
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  7. Shobna Bhatia
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  8. Akash Shukla
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Contributions

DA: coordination, data collection, unblinding and analysis, first draft. MM: data collection, unblinding and analysis. HD: data collection, unblinding and analysis. A Sadalage: protocol writing, manometry reader. DG: manometry reader. PA: manometry reader. SB: manometry reader. AS: conceived idea, protocol writing, manuscript writing, manometry reader, overall supervision. All authors approved the final manuscript.

Corresponding author

Correspondence to Akash Shukla.

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Conflict of interest

DA, MM, HD, AS, DG, PA, SB, and AS declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Agrawal, D., Meshram, M., Darak, H. et al. Intra- and inter-observer agreement in the classification of dyssynergic defecation on high-resolution anorectal manometry using water-perfusion system. Indian J Gastroenterol 41, 336–342 (2022). https://doi.org/10.1007/s12664-022-01239-2

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  • DOI: https://doi.org/10.1007/s12664-022-01239-2

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