Suction rectal biopsy yields adequate tissue in children

Background/purpose Hirschsprung disease (HD) is diagnosed by rectal biopsy, with suction rectal biopsy (SRB), the preferred technique in neonates. Reported SRB adequacy has varied overall with concern for decreased diagnostic yield in older children. The study aim was to assess SRB adequacy by age in children with the current device used at our institution. Methods Following IRB approval, a retrospective cohort of children (1 to 18 years) evaluated by SRB for HD was identified through billing records. Data regarding demographics, procedure, results, and complications were collected and analyzed using SPSS. Results 56 children (median age 3.9 years) underwent SRB with an 80.4% overall success rate. Patients older than 5 years had 90.5% adequacy rate compared to 74.3% in those younger. Univariate analysis revealed weak association of inadequate specimens with younger age and males, and no association with insurance, race/ethnicity, weight-height or BMI percentile, sedation type, or procedure location. SRB under general anesthesia (GA) had 100% adequacy (n = 6). Patients with inadequate initial biopsy achieved diagnosis by SRB with increased sedation (n = 5) or full thickness biopsy under GA (n = 5). Conclusion With adequacy of 80.4% overall and 90.5% for patients greater than 5 years, SRB is effective in evaluating the older child for HD.