Clinical and Translational Research
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2024; 16(10): 3288-3300
Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3288
Structured magnetic resonance imaging and endoanal ultrasound anal fistulas reporting template (SMART): An interdisciplinary Delphi consensus
Iwona Sudoł-Szopińska, Pankaj Garg, Anders Mellgren, Antonino Spinelli, Stephanie Breukink, Francesca Iacobellis, Małgorzata Kołodziejczak, Przemysław Ciesielski, Christian Jenssen, SMART Collaborative Group, Giulio Aniello Santoro
Iwona Sudoł-Szopińska, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw 02-637, Poland
Pankaj Garg, Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula 134113, Haryana, India
Anders Mellgren, Department of Surgical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia
Antonino Spinelli, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele – Milan, Italy
Antonino Spinelli, IRCCS Humanitas Research Hospital, Rozzano – Milan, Italy
Stephanie Breukink, Department of Surgery, Maastricht and NUTRIM Institute of Nutrition and Translational Research in Metabolism GROW - Research Institute for Oncology and Reproduction, the Netherlands
Francesca Iacobellis, Department of General and Emergency Radiology, A. Cardarelli Hospital, Naples 80131, Campania, Italy
Małgorzata Kołodziejczak, Przemysław Ciesielski, Warsaw Proctology Center, St. Elizabeth Hospital, Warsaw 02-616, Poland
Christian Jenssen, Department of Internal Medicine, Hospital Märkisch Oderland, Strausberg 15344, Brandenburg, Germany and Brandenburg Institute for Clinical Ultrasound, Neuruppin 16186, Brandenburg, Germany
Giulio Aniello Santoro, Third Referral Pelvic Floor Center, Division of Surgery 2, AULSS n.2 Marca Trevigiana, DISCOG University of Padua, Treviso, Italy
Author contributions: Sudol-Szopinska I, Garg P, and Santoro GA conceived and designed the study; all authors collected and analyzed the data, revised the data. All authors finally approved and submitted the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pankaj Garg, MS, CEO, Surgeon, Department of Colorectal Surgery, Garg Fistula Research Institute, 1042, Sector-15, Panchkula 134113, Haryana, India. drgargpankaj@gmail.com
Received: May 5, 2024
Revised: July 17, 2024
Accepted: August 23, 2024
Published online: October 27, 2024
Processing time: 144 Days and 19.2 Hours
Abstract
BACKGROUND

There is still considerable heterogeneity regarding which features of cryptoglandular anal fistula on magnetic resonance imaging (MRI) and endoanal ultrasound (EAUS) are relevant to surgical decision-making. As a consequence, the quality and completeness of the report are highly dependent on the training and experience of the examiners.

AIM

To develop a structured MRI and EAUS template (SMART) reporting the minimum dataset of information for the treatment of anal fistulas.

METHODS

This modified Delphi survey based on the RAND-UCLA appropriateness for consensus-building was conducted between May and August 2023. One hundred and fifty-one articles selected from a systematic review of the literature formed the database to generate the evidence-based statements for the Delphi study. Fourteen questions were anonymously voted by an interdisciplinary multidisciplinary group for a maximum of three iterative rounds. The degree of agreement was scored on a numeric 0–10 scale. Group consensus was defined as a score ≥ 8 for ≥ 80% of the panelists.

RESULTS

Eleven scientific societies (3 radiological and 8 surgical) endorsed the study. After three rounds of voting, the experts (69 colorectal surgeons, 23 radiologists, 2 anatomists, and 1 gastroenterologist) achieved consensus for 12 of 14 statements (85.7%). Based on the results of the Delphi process, the six following features of anal fistulas were included in the SMART: Primary tract, secondary extension, internal opening, presence of collection, coexisting lesions, and sphincters morphology.

CONCLUSION

A structured template, SMART, was developed to standardize imaging reporting of fistula-in-ano in a simple, systematic, time-efficient way, providing the minimum dataset of information and visual diagram useful to referring physicians.

Keywords: Anal fistulas; Fistula-in-ano; Template; Reporting; Magnetic resonance imaging; Endoanal ultrasound

Core tip: Magnetic resonance imaging (MRI) and endoanal ultrasound (EAUS) are the most used procedures for the preoperative assessment of cryptoglandular anal fistula. A Delphi study was planned. The protocol and the study were approved by 11 international surgical, colorectal, and radiological societies. A Delphi survey achieved 85.7% consensus among radiologists and colorectal surgeons on the minimum dataset of information relevant for decision-making. A structured MRI and EAUS template (SMART) was developed to standardize imaging reporting. This template could help radiologists and surgeons to report MRI and EAUS in a standardized manner.