Eur J Pediatr Surg
DOI: 10.1055/s-0038-1667040
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Accuracy of Suction Rectal Biopsy for Diagnosis of Hirschsprung's Disease in Neonates

Ashley Rebekah Allen
1  Department of Pediatric Surgery, School of Medicine, University of Utah Hospital, Salt Lake City, Utah, United States
,
Angelica R. Putnam
2  Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Angela P. Presson
3  Division of Epidemiology, University of Utah Hospital, Salt Lake City, Utah, United States
,
Chelsea McCarty Allen
3  Division of Epidemiology, University of Utah Hospital, Salt Lake City, Utah, United States
,
Douglas C. Barnhart
4  Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, United States
,
Michael D. Rollins
4  Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, United States
› Author Affiliations
Further Information

Publication History

10 March 2018

04 June 2018

Publication Date:
01 August 2018 (eFirst)

Abstract

Purpose Recent publications have questioned the sensitivity of suction rectal biopsy (SRB) for diagnosis of Hirschsprung's disease (HD) in newborns. A recent European survey reported that 39% of pediatric surgeons performed full-thickness transanal biopsies due to concerns about the accuracy of SRB. We sought to examine our contemporary SRB experience in infants.

Methods A review was performed (2007–2016) of patients under 6 months of age who had a SRB at our children's hospital. The cohort was subdivided by postmenstrual age at time of SRB: preterm (< 40 weeks, A), term neonate (40–44 weeks, B), and infant (> 44 weeks, C). The pathology reports from endorectal pull-through were used as gold standard confirmation. One-year follow-up of patients with negative SRB was used to confirm accurate diagnosis.

Results A total of 153 patients met the criteria and a total of 159 SRBs (< 2,500 g; n = 26) were performed (A = 60, B = 58, C = 35). Forty-three patients were diagnosed with HD (A = 25, B = 15, C = 3). A second SRB was performed in 6 (3.9%) patients due to inadequate tissue (A = 2, B = 2, C = 2) with HD diagnosed in 5. No complications occurred. Sensitivity and specificity of SRB was 100% in all age groups. Half of the patients with a negative SRB had at least 1 year follow-up, with none subsequently diagnosed with HD.

Conclusion SRB results in adequate tissue for evaluation of HD in nearly all patients less than 6 months of age on the first attempt and is highly accurate in the preterm and newborn infants. No complications occurred, even among infants less than 2,500 g.