Rectal Suction Biopsy in Patients With Previous Anorectal Surgery for Hirschsprung Disease.

Objectives: 1. To determine rates of histologically positive, negative and inconclusive rectal suction biopsies in post-pull-through patients with Hirschsprung disease evaluated for potential residual aganglionosis at our institution. 2. To determine how patients were managed after a post-pull-through rectal suction biopsy. Methods: Thirty-nine post-pull-through suction biopsies from our institution were reviewed. Samples, stained with H&E and often acetylcholinesterase and/or calretinin, were categorized as "histologically" positive, negative or inconclusive for aganglionosis. Subsequent clinical action was categorized as bowel resection, no further procedure, or re-biopsy. Agreement between histologic diagnosis and clinical action was assessed. Results: Histologically, all biopsies were inconclusive (46%) or negative (54%) for residual aganglionosis. Post-biopsy clinical action included re-do pull-through (5%), no further procedure (59%), or re-biopsy (36%). Re-biopsy was sought in 2 of 21 histologically negative patients and in only 12 of 18 histologically indeterminate patients. Eventual re-do pull-through procedures in 6 of 39 patients showed 4 with residual aganglionosis and 2 with abnormalities suggesting residual "transition zone." Conclusions: Our findings show that suction biopsy after pull-through was frequently histologically indeterminate and never definitively positive for residual aganglionosis. When biopsy was histologically indeterminate, re-biopsy was pursued less commonly than might be expected. Our findings emphasize that suction biopsy examination is not a "gold standard" for residual aganglionosis, but instead a component of a diagnosis that ultimately combines clinicopathologic factors, the constellation of which can sometimes spare patients from a more invasive full-thickness biopsy. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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