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

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• 作者：Camille L. Stewart^a ; ^b ; ^{Camille.Stewart@ucdenve.edu" class="auth_mail" title="E-mail the corresponding author} ; Ann M. Kulungowski^a ; ^b ; ^{Ann.Kulungowski@childrenscolorado.org" class="auth_mail" title="E-mail the corresponding author} ; Suhong Tong^c ; ^{Suhong.Tong@ucdenver.edu" class="auth_mail" title="E-mail the corresponding author} ; Jacob C. Langer^d ; ^{jacob.langer@sickkids.ca" class="auth_mail" title="E-mail the corresponding author} ; Jason Soden^e ; ^{Jason.Soden@childrenscolorado.org" class="auth_mail" title="E-mail the corresponding author} ; Stig Sø ; mme^a ; ^b ; ^{Stig.Somme@childrenscolorado.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Hirschsprung disease ; Rectal biopsy
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：51
• 期：4
• 页码：573-576
• 全文大小：196 K

文摘

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.