Evacuation proctography: A prospective study of diagnostic and therapeuticeffects

PURPOSE: To determine the diagnostic and therapeutic effects of evacuation proctography. MATERIALS AND METHODS: Forty-seven referring clinicians completed preevacua tion proctography questionnaires for 50 patients, detailing diagnoses, conf idence in these, intended management, and what they hoped to learn. After e vacuation proctography, the radiology report was returned with a second que stionnaire asking the diagnosis in the light of evacuation proctographic fi ndings, their confidence, and what they had learned. Clinicians quantified management contribution and indicated how useful they found evacuation proc tography in general. Results from pre- and post-evacuation proctography que stionnaires were compared to determine the diagnostic and therapeutic effec ts. RESULTS: Diagnostic confidence rose significantly after evacuation proctogr aphy (mean, 7.0 before evacuation proctography vs 8.4 after evacuation proc tography; P < .001). Lead diagnosis changed in nine (18%) patients. intende d surgical management became nonsurgical after evacuation proctography in s even (14%) patients, and intended nonsurgical therapy became surgical in tw o (4%). Surgery remained likely in 15 patients, but its nature changed in f ive (10%). Five (10%) clinicians stated that evacuation proctographic findi ngs resolved diagnostic conflict, and nine (18%) found that evacuation proc tographic findings revealed unsuspected diagnoses. Clinicians found evacuat ion proctography of major benefit in 20 (40%) cases studied and of moderate benefit in 20 (40%). In general, 20 (43%) clinicians found evacuation proc tography very useful and 24 (51%) found it moderately useful. CONCLUSION: Evacuation proctography has a substantial diagnostic and therap eutic effect and is of considerable benefit to referring clinicians.