Examining Balloon Expulsion Testing as an Office-Based, Screening Test for Dyssynergic Defecation: A Systematic Review and Meta-Analysis
Abstract
OBJECTIVES: Balloon expulsion testing (BET) is recommended to evaluate for dyssynergic defecation in patients with chronic constipation (CC). However, it remains poorly standardized and is limited to specialized centers. Our goal was to assess the clinical utility of balloon expulsion as an initial test for dyssynergic defecation and to determine appropriate testing parameters.
METHODS: We performed a literature search to identify cohort studies of unselected subjects with CC and case-control studies of subjects with/without dyssynergic defecation. We defined dyssynergic defecation by constipation symptoms and a positive reference test (anorectal manometry [ARM], defecography, or electromyography [EMG]). We performed a meta-analysis using a bivariate mixed-effects regression model to assess summary sensitivity, specificity, and area under the curve (AUC) with 95% confidence intervals (CI). We conducted a meta-regression to investigate individual test parameters and demographic variables.
RESULTS: We identified 15 eligible studies comprising 2090 individual assessments of BET. Among cohort studies, the AUC was 0.80 (95% CI: 0.61-0.91) with 70% sensitivity (95% CI: 52-83%) and 77% specificity (95% CI: 70-82%). In pooling cohort and case-control studies, the AUC was 0.84 (95% CI: 0.68-0.93) with 70% sensitivity (95% CI: 53-82%) and 81% specificity (95% CI: 75-86%). Subject positioning (seated vs. left lateral decubitus) did not significantly affect test performance in cohort (p…
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