Hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging in evaluating perianal fistulas: Agreement and patient preference

Rachel L. West, Soendersing Dwarkasing, Richelle J.F. Felt-Bersma, W. Ruud Schouten, Wim C.J. Hop, Shahid M. Hussain, Ernst J. Kuipers

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Objectives: To determine agreement between hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography (3D HPUS) and endoanal magnetic resonance imaging (MRI) in preoperative assessment of perianal fistulas, and to assess patient preference with regard to these techniques. Methods: Forty patients (31 males, aged 21-70 years) with symptoms of a perianal fistula and a visible external opening underwent preoperative 3D HPUS and endoanal MRI. The results were assessed separately by experienced observers. Fistulas were described according to the following characteristics: classification of the primary fistula tract according to Parks, location of the internal opening, presence of secondary tracts and fluid collections. Patients were asked to score the amount of discomfort experienced during both procedures and express their preference for either method. Results: The median time interval between 3D HPUS and endoanal MRI was 14 days (range, 0-91 days). The methods agreed in 88% (35/40, κ = 0.45) for the primary fistula tract, in 90% (36/40, κ = 0.83) for the location of the internal opening, in 78% (31/40, κ = 0.62) for secondary tracts, and in 88% (35/40, κ = 0.63) for fluid collections. Both methods were associated with similar discomfort, and there was no patient preference for one procedure over the other. Conclusions: 3D HPUS and endoanal MRI are equally adequate for the evaluation of perianal fistulas. Both methods are associated with similar discomfort and patients have no preference for either procedure.

Original languageEnglish (US)
Pages (from-to)1319-1324
Number of pages6
JournalEuropean Journal of Gastroenterology and Hepatology
Issue number12
StatePublished - Dec 1 2004



  • Endoanal magnetic resonance imaging
  • Hydrogen peroxide
  • Perianal fistula
  • Three-dimensional endoanal ultrasonography

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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