S1171 In the Gray Zone: Post-Diagnostic Journeys of Patients With Equivocal Anorectal Manometry Results

Introduction: Anorectal manometry (ARM) with balloon expulsion testing (BET) is an important tool for evaluating defecatory disorders. When ARM and BET results are equivocal, patients are often recommended MR defecography for further evaluation, although it is unclear what proportion of patients proceed with additional testing. Methods: This was a retrospective study of all patients who obtained an ARM and BET between January and March 2024 at a single tertiary care center. Our primary outcome was the percentage of patients who underwent MR defecography within 1 year of equivocal anorectal manometry results. Results: Of the 97 included participants, 71 (73%) were women, 41 (42%) were White. A total of 76 (78%) were referred for constipation, 17 (18%) were referred for fecal incontinence, and 4 (4%) had both. Of these, 24 (25%) had equivocal results and MR defecography was recommended. Within the following year, 11 (46%) of those recommended for MR defecography had obtained the imaging, 4 (17%) went directly to biofeedback and/or pelvic physical therapy instead, 8 (33%) were lost to follow-up, and 1 (4%) decided to try an alternative treatment. Of the 11 patients who underwent MR defecography, 6 (55%) passed the balloon expulsion test, 9 (82%) had rectal hyposensitivity, and 3 (27%) were referred by a motility specialist. Additionally, based on the results of MR defecography for these patients, 7 (64%) started or planned for pelvic floor physical therapy/biofeedback therapy, 1 (8%) did not demonstrate findings warranting biofeedback or pelvic physical therapy, and 3 (25%) were lost to follow up. Conclusion: Less than half of the patients referred for MR defecography obtained imaging within 1 year after equivocal ARM and BET results. Clinicians should carefully consider who may ultimately benefit from MR defecography versus an early referral for biofeedback or pelvic physical therapy, as many patients may not obtain additional testing.