High resolution anorectal manometry is useful tool for determining anorectal function, but can be difficult to perform the full awake procedure in paediatric settings due to the stigma surrounding intimate procedures on children and anxiety on the part of the young person, and many centres mainly investigate anorectal function under sedation. At our tertiary centre, we routinely perform awake high resolution anorectal manometry on children and young people of all ages with only rare occasions where no data at all is collected.

We retrospectively reviewed the last 100 patients to attend our centre for awake high resolution anorectal manometry and collected data on whether each of the six tests in the protocol (from the BSPGHAN working group consensus¹) were able to be performed and compared across five age groups.

The resting pressure test was almost universally successful across all age groups. As expected, almost all other tests were more successful as the children got older and able to better follow instructions and understand what was being requested of them. Of note however, the recto-anal inhibitory reflex (RAIR) showed a lower success rate in older children. On investigation, it appears that all RAIR test failures were a result of hyper sensitivity to the inflation of the balloon and active contraction of the sphincter in response to the sensation. These children has a subsequent positive RAIR under sedation. We theorise that older children are more likely to be aware of the urge to pass stool triggered by the RAIR testing and therefore more concerned about having an accident during the procedure than a younger child might be.

The relative success rates of each test will be of interest to referrers to predict what information they are likely to get out of a request for awake high resolution anorectal manometry – older children are more likely to be compliant for the entire protocol, but a majority of under 5s can produce meaningful data for at least half of the tests. Endurance squeeze and sensation testing proved the most challenging for our youngest group, likely due to a lack of understanding of the test requests, but can still be attempted where previous compliance with the testing protocol has been demonstrated.

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Abstract OC78 Figure 1

Percentage success of each test in the ARM protocol by age

References

1. Athanasakos E, Cleeve S, Thapar N, et al. Anorectal manometry in children with defecation disorders BSPGHAN Motility Working Group consensus statement. Neurogastroenterol Motil. 2020;32:e13797. https://doi.org/10.1111/nmo.13797