14781-koppen

153 Water-perfused colonic manometry 7 Ethics Committees of the South Eastern Area Health Service, Sydney, and the University of New South Wales (05/122; May 2010), and The Southern Adelaide Health Service/Flinders University Human Research Ethics Committee (419.10; March 2011). The inclusion and exclusion criteria for the adult constipated patients have been provided in detail previously. 13 Briefly, all patients were 19–75 years old, had slow-transit constipation confirmed scintigraphically, had normal anorectal function, and had failed symptomatic response to standard constipation therapies. Patients were excluded if they had metabolic, other neurological, or endocrine disorder(s) known to cause constipation, had prior abdominal radiotherapy, and current or planned pregnancy. Colonic catheters and recording setup In all children, a high-resolution water-perfused manometry catheter with 36 pressure sensors each spaced at 1.5-cm intervals was used (MMS, Enschede, The Netherlands, stationary manometry version 9.3K). The lumina were perfused with distilled water (0.15 mL/min). Intestinal intraluminal pressures were recorded by external pressure transducers, and pressure signals were digitized and stored on a computer. In all adults, colonic pressures were recorded with a 72-sensor (spaced 1 cm apart) high- resolution fiber-optic manometry catheter. 17 The fiber-optic catheters were attached to a spectral interrogator unit (FBG-scan 804; FOS&S, Geel, Belgium) and pressures were recorded in real time on a custom-written LabVIEW© program (National Instruments, Austin, TX, USA). Colonoscopic placement of the catheter Pediatric patients were admitted to the hospital prior to the manometry for colonic lavage with either Klean-Prep® or PicoPrep®, administered according to standard hospital procedures. The colonic lavage protocol was tailored to individual needs if necessary by increasing the number of days or dosage of laxatives. Children received a clear liquid diet starting 24 h before the colonoscopy and fasted overnight. Colonoscopy was performed under general anesthesia with Diprivan (dose varied depending based on body weight). A suture loop was tied to the tip of the catheter and covered with Parafilm M®. This loop was held by a snare passed through the biopsy channel of the colonoscope. With the aid of the colonoscope, the catheter tip was introduced into the distal transverse colon to ensure that there were recording sites spanning the descending and sigmoid colon. The suture loop was clipped to the mucosa of the transverse colon using hemostatic clips (Resolution Clip; Boston Scientific Corporation; Marlborough, MA, USA). The position of the catheter and any