{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T08:53:30Z","timestamp":1790931210176,"version":"4.1.0"},"reference-count":42,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>The aim of this exploratory study was to evaluate the performance of the anal EndoFLIP in diagnosing anismus in patients with functional constipation and suspected to have a dyssynergic defecation based on a composite reference standard (anorectal manometry, surface electromyography, and defecography).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients underwent anorectal manometry, surface electromyography, and defecography. At least two of the three tests needed to be positive to diagnose anismus. Anal EndoFLIP was performed during push maneuvers at 40 and 50\u2009mL of distension, and pressure\u2010cross\u2010sectional\u2010area (CSA) loops were built for each push maneuver to identify parameters that could best predict a diagnosis of anismus (ROC curve analysis). Two\u2010variable CSA\u2013pressure classifiers were evaluated using nested repeated five\u2010fold cross\u2010validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Diagnosis of anismus using the composite reference standard was made in 29\/57 patients (50.8%). An analysis of CSA\u2010pressure loops indicated that, at 40\u2009mL of distension, maximal absolute \u0394CSA and maximal relative \u0394CSA were lower compared to patients without anismus (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Among quantitative CSA indices, an exploratory threshold under 12.8\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      for a maximal absolute \u0394CSA at 40\u2009mL provided the highest accuracy and AUC (0.81) and excellent specificity (0.93) for the diagnosis of anismus. Using nested repeated cross\u2010validation, two\u2010variable GLM and CART classifiers yielded mean out\u2010of\u2010sample AUCs of 0.767 and 0.764 at 40\u2009mL and 0.754 and 0.658 at 50\u2009mL, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The results suggest that anal EndoFLIP may help distinguish patients with anismus from those without. Further external validation studies are needed to establish clinically applicable thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinical.trials.gov\">Clinical.trials.gov<\/jats:ext-link>\n                      : NCT04155307\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70452","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T08:07:13Z","timestamp":1790928433000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Value of the Anal Endoluminal Functional Luminal Imaging Probe for the Diagnosis of Anismus: An Exploratory Study"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1280-7675","authenticated-orcid":false,"given":"Charlotte","family":"Desprez","sequence":"first","affiliation":[{"name":"Department of Digestive Physiology Universit\u00e9 of Rouen Normandy, INSERM, ADEN UMR1073, CHU Rouen, CIC\u2010CRB 1404  Rouen France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8730-284X","authenticated-orcid":false,"given":"Thomas","family":"Duflot","sequence":"additional","affiliation":[{"name":"Department of Pharmacology University of Rouen Normandy, UNIROUEN, Inserm U1096, CHU Rouen, CIC\u2010CRB 1404  Rouen France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8146-1540","authenticated-orcid":false,"given":"Chlo\u00e9","family":"Melchior","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology University of Rouen Normandy, INSERM, ADEN UMR1073, CHU Rouen, CIC\u2010CRB 1404  Rouen France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8220-9155","authenticated-orcid":false,"given":"Guillaume","family":"Gourcerol","sequence":"additional","affiliation":[{"name":"Department of Digestive Physiology Universit\u00e9 of Rouen Normandy, INSERM, ADEN UMR1073, CHU Rouen, CIC\u2010CRB 1404  Rouen France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0272-7492","authenticated-orcid":false,"given":"Ali","family":"Zifan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine University of California  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0258-6757","authenticated-orcid":false,"given":"Estelle","family":"Houivet","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Clinical Research CHU Rouen  Rouen France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line","family":"Savoye\u2010Collet","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Rouen Normandy, AIMS, CHU Rouen  Rouen France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6266-4203","authenticated-orcid":false,"given":"Anne\u2010Marie","family":"Leroi","sequence":"additional","affiliation":[{"name":"Department of Digestive Physiology Universit\u00e9 of Rouen Normandy, INSERM, ADEN UMR1073, CHU Rouen, CIC\u2010CRB 1404  Rouen France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.164"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2026.01.037"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2026.02.003"},{"issue":"16","key":"e_1_2_10_5_1","first-page":"00175","article-title":"Functional Anorectal Disorders","volume":"0016","author":"Rao S. 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