{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T17:26:37Z","timestamp":1776360397389,"version":"3.51.2"},"reference-count":36,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["CM23\/00076"],"award-info":[{"award-number":["CM23\/00076"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obstetric anal sphincter injuries (OASIs) occur during childbirth, affecting up to 11.0% of women. Three\u2010Dimensional High\u2010Resolution Anorectal Manometry (3D\u2010HR\u2010ARM) provides an advanced evaluation of pathophysiological anorectal abnormalities and allows identification of potential lesions. The aim of the study was to evaluate the diagnostic accuracy and inter\u2010rater reliability of (3D\u2010HR\u2010ARM) in identifying OASIs compared to ultrasound assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted at a tertiary referral center from January 2021 to June 2023. Women with anal incontinence (AI) following a vaginal delivery underwent assessment with both 3D\u2010HR\u2010ARM and endoanal ultrasound (3D\u2010EAUS). Diagnostic accuracy in identifying anal sphincter defects was determined using 3D\u2010EAUS as the gold standard, and inter\u2010rater reliability was assessed among multiple observers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>\n                      Among 35 women, 19 had OASIs. For identifying severe residual defects (global Starck score \u2265\u20098), 3D\u2010HR\u2010ARM demonstrated an accuracy of 95.7% (95% CI 79.0\u201399.2), sensitivity of 100% (95% CI 64.6\u2013100), specificity of 93.8% (95% CI 71.7\u201398.9), positive predictive value (PPV) of 87.5% (95% CI 52.9\u201397.8), and negative predictive value of 100% (95% CI 79.6\u2013100). However, its accuracy decreased to 68.6% (95% CI 52.0\u201381.4) for detecting any sphincter defect. Inter\u2010rater agreement varied from good (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.60) to mild (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.27), depending on the observer pair.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>3D\u2010HR\u2010ARM shows potential for the identification of severe OASIs in women with AI symptoms. However, its moderate accuracy for mild defects and significant inter\u2010rater variability underscore the need for standardized protocols and additional training to improve reliability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70090","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T15:39:28Z","timestamp":1748878768000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diagnostic Accuracy and Inter\u2010Rater Reliability of Three\u2010Dimensional High Resolution Anorectal Manometry (3D\u2010HR\u2010ARM) in the Diagnosis of Obstetric Anal Sphincter Injuries (OASIs): A Feasibility Study"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1892-6317","authenticated-orcid":false,"given":"Alberto","family":"Ezquerra\u2010Dur\u00e1n","sequence":"first","affiliation":[{"name":"Neurogastroenterology and Motility Unit, Gastroenterology Department Hospital Clinic of Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Ros","sequence":"additional","affiliation":[{"name":"Pelvic Floor Unit, ICGON, Hospital Clinic of Barcelona University of Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8478-9659","authenticated-orcid":false,"given":"Jos\u00e9 Mar\u00eda","family":"Remes\u2010Troche","sequence":"additional","affiliation":[{"name":"Digestive Physiology and Motility Lab Veracruzana University  Xalapa Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karla Roc\u00edo","family":"Garc\u00eda\u2010Zerme\u00f1o","sequence":"additional","affiliation":[{"name":"Integral Center for Gastroenterology and Advanced Motility (CIGMA)  Veracruz Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina","family":"Luzko","sequence":"additional","affiliation":[{"name":"Neurogastroenterology and Motility Unit, Gastroenterology Department Hospital Clinic of Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7827-8019","authenticated-orcid":false,"given":"Isis K","family":"Araujo","sequence":"additional","affiliation":[{"name":"Neurogastroenterology and Motility Unit, Gastroenterology Department Hospital Clinic of Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5986-6592","authenticated-orcid":false,"given":"Elizabeth","family":"Barba","sequence":"additional","affiliation":[{"name":"Neurogastroenterology and Motility Unit, Gastroenterology Department Hospital Clinic of Barcelona  Barcelona 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