A new study published in The American Journal of Gastroenterology assessed the clinical utility of balloon expulsion testing (BET) as an initial test for dyssynergic defecation and to determine appropriate testing parameters. This study entailed a literature search to identify cohort studies of unselected subjects with CC and case-control studies of subjects with or without dyssynergic defecation. Here, dyssynergic defecation was defined by constipation symptoms and a positive reference test (anorectal manometry [ARM], defecography, or electromyography [EMG]). A meta-analysis using a bivariate mixed-effect regression model was performed to assess summary sensitivity, specificity, and area under the curve (AUC) with 95% confidence intervals (CI). Individual test parameters and demographic variables were investigated. Overall, 15 studies were selected comprising 2,090 individual assessments of BET. Among cohort studies, the AUC was 0.80 with 70% sensitivity and 77% specificity. Meanwhile, in pooling cohort and case-control studies, the AUC was 0.84 with 70% sensitivity and 81% specificity. On the other hand, subject positioning did not significantly affect test performance in cohort or case-control analysis. A majority of the studies evaluated 50-60 mL water insufflation. While test performance was not significantly affected by varying the maximum allowed expulsion time between 1-5 min. It was speculated that age and gender accounted for significant study heterogeneity. Whereas, the choice of reference test, continent of study, and year of study did not significantly affect test performance. Thus, the performance characteristics of BET could support its use as a point of service test to screen for dyssynergic defecation in chronically constipated subjects.