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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/
Original Articles: Gastroenterology

At What Age Is a Suction Rectal Biopsy Less Likely to Provide Adequate Tissue for Identification of Ganglion Cells?

Croffie, Joseph M*; Davis, Mary M; Faught, Philip R; Corkins, Mark R*; Gupta, Sandeep K*; Pfefferkorn, Marian D*; Molleston, Jean P*; Fitzgerald, Joseph F*

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Objective: The objective of this study was to determine at what age suction rectal biopsy is less likely to provide adequate tissue to detect submucosal ganglion cells in a child being evaluated for Hirschsprung disease.

Patients and Methods: Children ≥1 year of age undergoing a rectal biopsy at a single children's hospital had 1 biopsy each obtained simultaneously with a suction biopsy device and a grasp biopsy forceps. The biopsies were examined by 2 pathologists for adequacy of the submucosa (none, scant, adequate, or ample) and the presence of ganglion cells. The 2 specimens were compared with each other.

Results: One hundred fifty-two children 1 to 17 years of age were included. Fifty-three were female. Subjects were grouped into 4 age categories: 1 to 3 years (group A), 4 to 6 years (group B), 7 to 9 years (group C), and ≥10 years (group D). Similar numbers of patients were recruited for each group. Ganglion cells were identified in 73% and 90% by the suction and grasp devices, respectively, in group A. In groups B through D, ganglion cells were identified in 50% to 53% vs 92% to 97% of the suction and grasp biopsies, respectively (P < 0.001). Submucosa was present in 88% (suction) vs 98% (grasp) in group A, 70% vs 95% in group B, 69% vs 94% in group C, and 45% vs 92% in group D.

Conclusion: The suction rectal biopsy is less likely to provide adequate submucosa for identification of ganglion cells after 3 years of age.

© 2007 Lippincott Williams & Wilkins, Inc.


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