At what age is a suction rectal biopsy less likely to provide adequate tissue for identification of ganglion cells?
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.
Croffie
Joseph M
JM
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis 46202-5225, USA.
Davis
Mary M
MM
Faught
Philip R
PR
Corkins
Mark R
MR
Gupta
Sandeep K
SK
Pfefferkorn
Marian D
MD
Molleston
Jean P
JP
Fitzgerald
Joseph F
JF
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