Barium Enema Revisited in the Workup for the Diagnosis of Hirschsprung's Disease

The diagnostic capacity of barium enema (BE) in the diagnostic investigation for Hirschsprung's disease (HD) was analyzed for transition zone (TZ) identification and rectosigmoid index (RSI) ≤ 1.0 determination. BE images were analyzed retrospectively by two examiners and the results were compared with the histopathology of rectal biopsies. TZ identification and RSI ≤ 1.0 were assessed separately and combined in 43 patients. Twelve (27.9%) patients had the diagnosis of HD based on rectal biopsies. TZ identification presented better diagnostic capacity for the two examiners than RSI ≤ 1.0. However, inter-examiner agreement was higher for RSI ≤ 1.0 than for TZ identification. The combination of TZ identification and RSI≤ 1.0 increased the sensitivity (83.3% to 92.3%) and the negative predictive value (90.4% to 92.3%). Therefore, the high diagnostic sensitivity of TZ identification combined to RSI ≤ 1.0 reinforces the usefulness of these BE parameters in the screening for Hirschsprung's disease. Address correspondence and reprint requests to Pedro Luiz Toledo de Arruda Lourenção, Department of Surgery, Division of Pediatric Surgery, Botucatu Medical School, Unesp - Sao Paulo State University, Botucatu-SP, Brazil – CEP 18618-687 (e-mail: plourencao@gmail.com). Received 20 June, 2018 Accepted 6 December, 2018 The study did not receive support or funding from any organization. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Author contributions Pedro Luiz Toledo de Arruda Lourencao was responsible for the study conception and design, performed the radiological analysis, the interpretation of data and drafted the manuscript. Felipe Gilberto Valerini was responsible for acquisition of data, analysis and interpretation of data and drafted the manuscript. Antonio Jose Maria Cataneo was responsible for analysis and interpretation of data.and revised the manuscript critically. Erika Veruska Paiva Ortolan was responsible for the study conception and design, performed the interpretation of data and drafted the manuscript. Guilherme Lopes da Silveira performed the radiological analysis. Mariana Floriano Luiza Piva was responsible for acquisition of data, analysis and interpretation of data. Lucas da Matta Cucco was responsible for acquisition of data, analysis and interpretation of data. Maria Aparecida Marchesan Rodrigues was responsible for analysis and interpretation of data and revised the manuscript critically. © 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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