3D Echo Defecography (Sitzmarks)

3D Echo defecography may be used as an alternative method to assess patients with OD as it has been shown to detect the same anorectal dysfunctions observed in DF. It is minimally invasive, well tolerated, inexpensive, avoids exposure to radiation, and clearly demonstrates all the anatomic structures involved with defecation.

Sitzmarks is a colonic transit diagnostic test that helps physicians select the best therapeutic option for adult patients with severe constipation who have otherwise negative GI evaluations. The Sitzmarks test can help physicians diagnose hypomotility, colonic inertia and functional outlet obstruction.

Constipation is a major medical problem in the United States, affecting 2% to 28% of the population. Individual patients may have different conceptions of what constipation is, and the findings overlap with those in other functional gastrointestinal disorders. In 1999, an international panel of experts laid out specific criteria for the diagnosis of constipation known as the Rome II criteria. When patients present with complaints of constipation, a complete history and physical examination can elicit the cause of constipation. It is imperative to rule out a malignancy or other organic causes of the patient's symptoms prior to making the diagnosis of functional constipation. Many patients' symptoms can be relieved with lifestyle and dietary modification, both of which should be implemented before other potentially unnecessary tests are performed.

Functional constipation is divided into two subtypes: slow transit constipation and obstructive defecation. Because many different terms are used interchangeably to describe these subtypes of constipation, physicians need to be comfortable with the language.

Slow transit constipation is due to abnormal colonic motility. The diagnosis is made with the use of a colonic transit study. We continue to use a single-capsule technique as first described in the literature, but modifications of the capsule technique as well as scintigraphic techniques are validated and can be substituted in place of the capsule.

Obstructive defecation is a much more complex problem, with etiologies ranging from rare diseases such as Hirschsprung's to physiologic abnormalities such as paradoxical puborectalis contraction. To fully evaluate the patient with obstructive defecation, anorectal manometry, defecography, and electromyography should be utilized. The different techniques available for each test are fully covered in this article.

When evaluating each patient with constipation, it is important to keep in mind that the disease may be specific to one subtype or a combination of both subtypes. Because it is difficult to differentiate the subtypes from the patient's history, we feel it is imperative to evaluate patients fully for both slow transit and obstructive defecation prior to any surgical intervention. Furthermore, we have described many tests that need to be applied to one's population of patients on the basis of the capabilities and expertise the institution offers.

 

SmartPill Capsule-Based GI Testing

This is a crucial test in evaluating patients with gastrointestinal symptoms such as irritable bowel syndrome (IBS), bloating, nausea, abdominal pain, constipation, and fullness.

smartpil photoIt is pain-free and less invasive than most other GI procedures. Once the capsule is ingested, this device collects important information such as pressure, PH and temperature and transmits this data to a receiver the patient wears on a belt for a period of four days.

The physician then downloads the input to his computer and reviews the test results with the patient. This greatly facilitates the patient’s diagnosis and treatment plan without any discomfort or disruption of normal activities for the patient.


Dr. Galliano is the most experienced Board Certified Colorectal Surgeon with Da Vinci Robotic Surgery in Lee, Charlotte, Sarasota, and De Soto Counties! He has performed over 100 DaVinci Robotic procedures!


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Solesta is a sterile gel injected into the anus to treat the symptoms of fecal incontinence.


Esophyx long-term incisionless solution for chronic acid reflux GERD


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