Real‑world Application of the International Anorectal Physiology Working Group Standardized Protocol and London Classification: A Multi‑country Cross‑sectional Survey of Anorectal Manometry Practice in Asia
- Author:
Seon-Young PARK
1
;
Kee Wook JUNG
;
Myeongsook SEO
;
Han Hee LEE
;
Ju Yup LEE
;
Soo In CHOI
;
Jong Wook KIM
;
Chong Il SOHN
;
Suck Chei CHOI
Author Information
- Publication Type:Original Article
- From:Journal of Neurogastroenterology and Motility 2026;32(2):267-275
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:The International Anorectal Physiology Working Group (IAPWG) has proposed a standardized protocol and the London classification to enhance the consistency and diagnostic accuracy of anorectal manometry (ARM). However, real-world adoption in Asian countries has not been systematically assessed. This study aims to evaluate current ARM practices and adherence to the IAPWG protocol across Asian centers.
Methods:A cross-sectional, 50-item web-based survey was distributed to gastroenterologists and motility specialists practicing in Asian countries.
Results:Thirty-one centers from 8 countries responded (20 in Korea, 3 in Japan, 2 in Taiwan, 1 in China, and 7 in other countries). High-resolution ARM was used in 80.6% of centers, primarily with solid-state catheters. While all centers performed rest and short squeeze maneuvers, only 58.1% conducted all maneuvers recommended by the IAPWG protocol.Considerable variation was observed in test methodology and interpretation, including definitions of resting pressure, squeeze duration, push maneuver repetition, and rectal balloon volume for rectoanal inhibitory reflex. For balloon expulsion and rectal sensory testing, centers differed in patient positioning, balloon type, inflation methods, and threshold definitions. Only 38.7% of centers reported having institutional normative values for test interpretation, and 64.5% applied the London classification.
Conclusions:Across Asian centers, ARM practice shows marked regional variation and incomplete implementation of the IAPWG standardized protocol and London classification, highlighting persistent gaps in standardization. Strengthening procedural guidance, regionally appropriate normative data, and interpretation criteria through coordinated education and international collaboration is needed to support more consistent and clinically meaningful use of ARM in routine practice.
