title: Rectal biopsies obtained with jumbo biopsy forceps in the evaluation of Hirschsprung disease.
abstract: OBJECTIVE
  Refractory constipation is an extremely common problem in infants and children. The diagnostic suspicion of Hirschsprung disease often arises in this clinical setting. Diagnosing Hirschsprung disease can be difficult; however, excluding the diagnosis is much easier, only requiring the demonstration of ganglion cells in the distal rectum. The most common method for obtaining tissue from the rectum involves a blind suction biopsy. This technique has been complicated by serious adverse events, equipment malfunction, and inadequate specimens. Our goal was to evaluate the adequacy of specimens obtained with a flexible endoscope and jumbo biopsy forceps to rule out Hirschsprung disease in the child outside the newborn period.
  
  
  METHODS
  We retrospectively reviewed 668 rectal biopsies taken during 167 endoscopies on 156 patients being evaluated for Hirschsprung disease from 2001 to 2008 at the Baystate Medical Center Children's Hospital. Four biopsies were taken from each patient approximately 2.5 cm from the anal verge. Biopsies were obtained using a flexible endoscope and jumbo biopsy forceps. During the first 6 years the Olympus FB-50U-1 large cup fenestrated biopsy forceps was used. During the last 2 years the Boston Scientific Radial Jaw 4 Jumbo biopsy forceps was used instead.
  
  
  RESULTS
  The Boston Scientific Radial Jaw 4 Jumbo biopsy forceps yielded adequate specimens 93% of the time, which surpassed most published results of other techniques. There were no complications reported.
  
  
  CONCLUSIONS
  Obtaining rectal biopsies with a flexible endoscope and jumbo biopsy forceps is a safe and effective means to rule out the diagnosis of Hirschsprung disease in children.
authors.affiliation: Division of Pediatric Gastroenterology and Nutrition, Baystate Medical Center Children's Hospital, Springfield, MA, USA. barry.hirschmd@bhs.org
authors.forename: Barry Z
authors.initials: BZ
authors.lastname: Hirsch
authors.forename: Anastasios G
authors.initials: AG
authors.lastname: Angelides
authors.forename: Susan P
authors.initials: SP
authors.lastname: Goode
authors.forename: Jane L
authors.initials: JL
authors.lastname: Garb
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D006627:Hirschsprung Disease / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology; D011351:Proctoscopy / Q000295:instrumentation; D012007:Rectum / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult