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Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5
Published on: April 26, 2019
Rectal biopsies obtained with jumbo biopsy forceps in the evaluation of Hirschsprung disease
Barry Z Hirsch1, Anastasios G Angelides, Susan P Goode
1Division of Pediatric Gastroenterology and Nutrition, Baystate Medical Center Children's Hospital, Springfield, MA, USA. barry.hirschmd@bhs.org
Insights
Using flexible endoscopy with jumbo biopsy forceps is a safe and effective way to rule out Hirschsprung disease in children, yielding adequate rectal biopsy specimens in 93% of cases.
Area of Science:
- Pediatric Gastroenterology
- Surgical Pathology
- Diagnostic Endoscopy
Background:
- Refractory constipation is common in children, often raising suspicion for Hirschsprung disease.
- Diagnosing Hirschsprung disease can be challenging; excluding it requires identifying rectal ganglion cells.
- Traditional blind suction biopsies have limitations, including adverse events and inadequate specimens.
Purpose of the Study:
- To evaluate the adequacy of rectal biopsy specimens obtained via flexible endoscopy and jumbo biopsy forceps.
- To assess the safety and efficacy of this method for ruling out Hirschsprung disease in children outside the newborn period.
Main Methods:
- Retrospective review of 668 rectal biopsies from 156 patients evaluated for Hirschsprung disease (2001-2008).
- Biopsies were obtained using flexible endoscopy and jumbo biopsy forceps (Olympus or Boston Scientific) approximately 2.5 cm from the anal verge.
- Four biopsies were taken per patient.
Main Results:
- The Boston Scientific Radial Jaw 4 Jumbo biopsy forceps achieved adequate specimens in 93% of cases.
- This success rate surpassed most published results from other biopsy techniques.
- No complications were reported during the procedures.
Conclusions:
- Flexible endoscopy with jumbo biopsy forceps provides safe and effective rectal biopsies.
- This technique is a reliable method for ruling out Hirschsprung disease in pediatric patients.
- The Boston Scientific Radial Jaw 4 Jumbo biopsy forceps demonstrated high adequacy rates.
Background And Aim:
Refractory constipation is an extremely common problem in infants and children. The diagnostic suspicion of Hirschsprung disease often arises in this clinical setting. Diagnosing Hirschsprung disease can be difficult; however, excluding the diagnosis is much easier, only requiring the demonstration of ganglion cells in the distal rectum. The most common method for obtaining tissue from the rectum involves a blind suction biopsy. This technique has been complicated by serious adverse events, equipment malfunction, and inadequate specimens. Our goal was to evaluate the adequacy of specimens obtained with a flexible endoscope and jumbo biopsy forceps to rule out Hirschsprung disease in the child outside the newborn period.
Patients And Methods:
We retrospectively reviewed 668 rectal biopsies taken during 167 endoscopies on 156 patients being evaluated for Hirschsprung disease from 2001 to 2008 at the Baystate Medical Center Children's Hospital. Four biopsies were taken from each patient approximately 2.5 cm from the anal verge. Biopsies were obtained using a flexible endoscope and jumbo biopsy forceps. During the first 6 years the Olympus FB-50U-1 large cup fenestrated biopsy forceps was used. During the last 2 years the Boston Scientific Radial Jaw 4 Jumbo biopsy forceps was used instead.
Results:
The Boston Scientific Radial Jaw 4 Jumbo biopsy forceps yielded adequate specimens 93% of the time, which surpassed most published results of other techniques. There were no complications reported.
Conclusions:
Obtaining rectal biopsies with a flexible endoscope and jumbo biopsy forceps is a safe and effective means to rule out the diagnosis of Hirschsprung disease in children.
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