title: Out with the old and in with the new: a comparison of rectal suction biopsies with traditional and modern biopsy forceps.
abstract: OBJECTIVE
  Rectal suction biopsy, the gold standard for the diagnosis of Hirschsprung disease, has been associated with a varying incidence of complications and inadequate biopsy. The rbi2 is a modern alternative to the 'Noblett' biopsy forceps and has recently become available. The aim of this study was to compare the performance of this novel tool with the Noblett forceps.
  
  
  METHODS
  Single-center retrospective study of all infants (<1 year) undergoing rectal suction biopsy from January 2004 to December 2007. During the study period, 2 different biopsy forceps were used--the Noblett forceps (first 2.5 years) and the rbi2 (last 1.5 years). A specimen was defined as inadequate if it was too small or contained inadequate submucosa for histological diagnosis. Fisher's Exact test and Mann-Whitney U test were used as appropriate.
  
  
  RESULTS
  During the study period, 238 specimens were obtained from 88 infants in 102 biopsy episodes. Overall, 13 episodes were inadequate. There were no demographic differences between the 2 groups, and no serious complications (hemorrhage requiring transfusion, rectal perforation, pelvic sepsis) occurred in any infant. A significantly higher proportion of specimens taken with the Noblett forceps were inadequate compared with the rbi2 (Noblett 30/153 [20%] vs rbi2 6/85 [7%]; Relative risk (RR) = 2.8; 95% confidence interval, 1.2-6.3; P = .01). There was a nonsignificantly higher incidence of inadequate biopsy episode with the Noblett forceps compared with the rbi2 (Noblett 10/63 [16%] vs rbi2 3/40 [7%]; RR = 2.2; 95% confidence interval, 0.6-7.3; P = .24). The rbi2 carries a small cost premium for each biopsy episode compared with the Noblett forceps, but this is low when compared with the cost of repeat biopsy.
  
  
  CONCLUSIONS
  Rectal suction biopsy is a safe procedure with a low incidence of complications. The rbi2 offers superior efficacy over the Noblett forceps, and its use is likely to be more cost-effective.
authors.affiliation: Department of Paediatric Surgery, University Hospital Lewisham, London, UK. n.hall@ich.ucl.ac.uk
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Hall
authors.forename: D
authors.initials: D
authors.lastname: Kufeji
authors.forename: A
authors.initials: A
authors.lastname: Keshtgar
mesh_terms: D001706:Biopsy / Q000295:instrumentation / Q000379:methods; D005260:Female; D006627:Hirschsprung Disease / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012007:Rectum / Q000473:pathology*; D012189:Retrospective Studies