Share This Article:

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

Full-Text HTML Download Download as PDF (Size:118KB) PP. 15-19
DOI: 10.4236/ss.2014.51004    2,960 Downloads   4,503 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.

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.

References

[1] K. Vult von Steyern, P. Wingren, M. Wiklund, P. Stenstrom and E. Arnbjornsson, “Visualisation of the Rectoanal Inhibitory Reflex with a Modified Contrast Enema in Children with Susected Hirschsprung Disease,” Pediatric Radiology, Vol. 43, No. 8, 2013, pp. 950-957. http://dx.doi.org/10.1007/s00247-013-2622-4
[2] D. Spouge and P. A. Baird, “Hirschsprung Disease in a Large Birth Cohort,” Teratology, Vol. 32, No. 2, 1985, pp. 171-177. http://dx.doi.org/10.1002/tera.1420320204
[3] A. Ghosh and D. M. Griffiths, “Rectal Biopsy in the Investigation of Constipation,” Archives of Disease in Childhood, Vol. 79, No. 3, 1998, pp. 266-268. http://dx.doi.org/10.1136/adc.79.3.266
[4] C. C. Lee, R. Lien, M. C. Chiang, P. H. Yang, S. M. Chu, J. H. Fu and J. Y. Lai, “Clinical Impacts of Delayed Diagnosis of Hirschsprung’s Disease in Newborn Infants,” Pediatrics & Neonatology, Vol. 53, No. 2, 2012, pp. 133-137. http://dx.doi.org/10.1016/j.pedneo.2012.01.011
[5] J. C. Langer, “50 Years Ago in the Journal of Pediatrics: Rectal Biopsy as an Aid in the Diagnosis of Diseases of Infants and Children,” Journal of Pediatrics, Vol. 162, No. 2, 2013, p. 301.
http://dx.doi.org/10.1016/j.jpeds.2012.09.020
[6] E. Gilbert-Barness, R. P. Kapur, L. L. Oligny and J. R. Siebert, “Potter’s Pathology of the Fetus, Infant and Child,” 2nd Edition, Mosby Elesevier, Philadelphia, 2007, p. 1176.
[7] W. O. Dobbins and A. H. Bill, “Diagnosis of Hirschsprung’s Disease Excluded by Rectal Suction Biopsy,” The New England Journal of Medicine, Vol. 272, No. 19, 1965, pp. 990-993.
http://dx.doi.org/10.1056/NEJM196505132721903
[8] C. E. Hayes, D. Kawatu, S. Mangray and N. S. LeLeiko, “Rectal Suction Biopsy to Exclude the Diagnosis of Hirschsprung Disease,” Journal of Pediatric Gastroenterology and Nutrition, Vol. 55, No. 3, 2012, pp. 268-271. http://dx.doi.org/10.1097/MPG.0b013e31824c0acc
[9] E. A. Ali, J. A. Morecroft, J. C. Bowen, J. Bruce and A. Morabito, “Wall or Machine Suction Biopsy for Hirschsprung’s Disease: A Simple Modified Technique Can Improve the Adequacy of Biopsy,” Pediatric Surgery International, Vol. 22, No. 8, 2006, pp. 681-682. http://dx.doi.org/10.1007/s00383-006-1714-8
[10] N. J. Hall, D. Kufeji and A. Keshtgar, “Out with the Old and in with the New: A Comparison of Rectal Suction Biopsies with Traditional and Modern Biopsy Forceps,” Journal of Pediatric Surgery, Vol. 44, No. 2, 2009, pp. 395-398. http://dx.doi.org/10.1007/s00383-006-1714-8
[11] J. Kessman, “Hirschsprung’s Disease: Diagnosis and Management,” American Family Physician, Vol. 74, No. 8, 2006, pp. 1319-1322.
[12] B. I. Rees, A. Azmy, M. Nigam and B. D. Lake, “Complications of Rectal Suction Biopsy,” Journal of Pediatric Surgery, Vol. 18, No. 3, 1983, pp. 273-275. http://dx.doi.org/10.1016/S0022-3468(83) 80098-0
[13] A. Pini-Prato, C. Carlini, F. Pesce, V. Jasonni and P. Seymandi, “Massive Bleeding after Rectal Suction Biopsy: Uncommon and Unexpected Delayed Onset,” World Journal of Pediatrics, Vol. 7, No. 1, 2011, pp. 83-85. http://dx.doi.org/10.1007/s12519-011-0251-2
[14] J. A. C. Sterne and G. Davey Smith, “Shifting the Evidence—What’s Wrong with Significance Tests?” Physical Therapy, Vol. 81, No. 8, 2001, pp. 1464-1469.
[15] R. Core Team “R: A Language and Environment for Statistical Computing,” R Foundation for Statistical Computing, Vienna, 2013. http://www.R-project.org/

  
comments powered by Disqus

Copyright © 2017 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.