title: At what age is a suction rectal biopsy less likely to provide adequate tissue for identification of ganglion cells?
abstract: 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.
  
  
  METHODS
  Children > or =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 > or =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.
  
  
  CONCLUSIONS
  The suction rectal biopsy is less likely to provide adequate submucosa for identification of ganglion cells after 3 years of age.
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis 46202-5225, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Croffie
authors.forename: Mary M
authors.initials: MM
authors.lastname: Davis
authors.forename: Philip R
authors.initials: PR
authors.lastname: Faught
authors.forename: Mark R
authors.initials: MR
authors.lastname: Corkins
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Gupta
authors.forename: Marian D
authors.initials: MD
authors.lastname: Pfefferkorn
authors.forename: Jean P
authors.initials: JP
authors.lastname: Molleston
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Fitzgerald
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005725:Ganglia, Autonomic / Q000473:pathology*; D006627:Hirschsprung Disease / Q000473:pathology*; D006801:Humans; D007223:Infant; D008297:Male; D012007:Rectum / Q000473:pathology*; D013048:Specimen Handling