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A Comparison of Rectal Suction and Full Wall Biopsy in Hirschsprung’s Disease

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DOI: 10.4236/ss.2014.51004    3,189 Downloads   4,881 Views   Citations

ABSTRACT

Introduction: Hirschsprung’s disease (HD) is defined as congenital agangliosis of the colon wall from the rectum extending cranially. There are several radiologic methods for screening for HD but it is a biopsy of the colon wall that confirms the diagnosis. Initially the full wall (FW) biopsy was the method of choice. FW biopsy requires general anaesthesia and creates a full wall laceration of the colon wall. The newer method called rectal suction (RS) biopsy is carried out by means of a catheter inserted into the rectum that blindly cuts a biopsy including mucosa and submucosa. It can be performed bedside. If ganglion cells are seen in the biopsy specimen, HD can be excluded. The question that arises is: Can we safely move on from FW biopsy to RS biopsy without compromising diagnostic accuracy? Method and Material: Our study is a retrospective revision of 20 FW biopsies that were supplemented with RS biopsies. RS biopsies with insufficient submucosa were excluded. The RS biopsies were assessed by a senior pathologist in a double blind fashion and the result was compared with FW biopsies. FW biopsy was considered gold standard. Results: The exact binominal test for the non-inferiority test of congruence of RS biopsy with FW biopsy as gold standard was not statistically significant using an inferiority margin of 80% (p = 0.06918) [H0: p_RS < 0.8, HA: p_RS ≥ 0.8]. The estimated probability for a successful RS biopsy was 95% and the one-sided 95%-confidence interval associated with the test was 0.784 to 1.00. Conclusion: Our results indicate that we can move on from FW biopsy to RS biopsy without compromising the diagnostic value of the rectal biopsy in a clinically significant way. A prospective study to confirm our results would be of great value.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

S. Ax, E. Arnbjörnsson and D. Gisselsson-Nord, "A Comparison of Rectal Suction and Full Wall Biopsy in Hirschsprung’s Disease," Surgical Science, Vol. 5 No. 1, 2014, pp. 15-19. doi: 10.4236/ss.2014.51004.

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