Rectal biopsies for Hirschsprung disease: Patient characteristics by diagnosis and attending specialty

• Published in: Journal of pediatric surgery Vol. 51; no. 4; pp. 573 - 576
• Main Authors: Stewart, Camille L, Kulungowski, Ann M, Tong, Suhong, Langer, Jacob C, Soden, Jason, Sømme, Stig
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016
• Subjects: Biopsy - statistics & numerical data; Constipation - etiology; Female; Gastroenterology - statistics & numerical data; Gestational Age; Hirschsprung disease; Hirschsprung Disease - complications; Hirschsprung Disease - diagnosis; Hirschsprung Disease - pathology; Humans; Infant; Infant, Newborn; Logistic Models; Male; Pediatrics; Pediatrics - statistics & numerical data; Rectal biopsy; Rectum - pathology; Retrospective Studies; Surgery; Hirschsprung disease; Rectal biopsy
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2015.10.047

Abstract Purpose Hirschsprung disease (HD) is diagnosed with rectal biopsy. At our institution two services perform these biopsies: pediatric surgery and gastroenterology. Our objective was to review our institutional experience with rectal biopsies to diagnose HD and compare patients and outcomes between the two services. Methods We reviewed all children undergoing a rectal biopsy for the evaluation of HD at our institution over a 10-year period. Comparisons were made using multiple logistic regression models. Results We identified 518 children who underwent rectal biopsy for evaluation of HD; 451/518 (87%) were adequate and 56/518 (11%) were positive for HD. A positive biopsy was more likely with delayed passage of meconium (p < 0.001), obstructive symptoms (p < 0.001), trisomy 21 (p < 0.001), full-term gestation (p = 0.03), and male gender (p = 0.02). Pediatric surgeons biopsied younger patients with more classic symptoms for HD compared to gastroenterologists. Pediatric surgeons were more likely to take adequate (OR 6.0, 95% CI 2.9–12.4, p < 0.001) and positive biopsies (OR 6.7 95% CI 2.1–21.2, p = 0.001) compared to gastroenterologists. Conclusion Infants with classic symptoms can reliably be diagnosed with HD by a pediatric surgeon. The work up for HD in older children with constipation should be a collaborative effort between pediatric surgery and gastroenterology.