Rectal mucosal/submucosal biopsy under general anesthesia ensures optimum diagnosis of bowel motility disorders.
OBJECTIVE
We reviewed all rectal mucosal/submucosal biopsies (RMSBx) performed between 1986 and 2015 focusing on specimen quality, incidence of complications during and after biopsy, and parental satisfaction.


METHODS
From 1986 to 2004, RMSBx were performed without general anesthesia (GA) (N-GA; n = 98) and from 1995 to 2015 were performed under GA (GA; n = 525). In GA cases, some sections were stained intraoperatively and examined by a pathologist and pediatric surgeon immediately to identify ganglion cells.


RESULTS
Mean ages at RMSBx were similar (2.7 vs. 2.5 years; p = NS). There were significantly more inadequate specimens in N-GA [18/98 (18.4 %) vs. 0/525 (0 %); p < 0.0001]. Incidence of rectal bleeding requiring transfusion was significantly lower in GA [0/525 (0 %) versus 2/98 (2.0 %); p = 0.024]. Parents of GA subjects willingly consented to RMSBx when told GA would facilitate diagnosis. Incidentally, RMSBx was more expensive in GA (US$1320 versus US$294; using ¥120 = US$1).


CONCLUSIONS
RMSBx performed under GA are safe and all specimens obtained included submucosa appropriate for optimum diagnosis in all the cases.
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Takaaki
T
Imaizumi
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. hmuraka@juntendo.ac.jp.
Hiroshi
H
Murakami
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Hiroki
H
Nakamura
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Shogo
S
Seo
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Hiroyuki
H
Koga
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Go
G
Miyano
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Manabu
M
Okawada
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Takashi
T
Doi
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Geoffrey J
GJ
Lane
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Tadaharu
T
Okazaki
Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
Atsushi
A
Arakawa
Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
Takashi
T
Yao
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Atsuyuki
A
Yamataka
D000768:Anesthesia, General; D001706:Biopsy; D002675:Child, Preschool; D005260:Female; D006627:Hirschsprung Disease / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D008297:Male; D009092:Mucous Membrane / Q000473:pathology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012007:Rectum / Q000473:pathology*
Constipation; Hirschsprung's disease; Rectal mucosal biopsy
N Engl J Med. 1965 May 13;272:990-3
14279253
Pediatr Surg Int. 2002 Dec;18(8):753-6
12598984
J Pediatr Surg. 2006 Jun;41(6):1043-8
16769331
J Pediatr Surg. 1969 Aug;4(4):406-9
5803818
Arch Pathol Lab Med. 1978 May;102(5):244-7
580561
Pediatr Surg Int. 2015 Sep;31(9):821-30
26156878
Pediatr Surg Int. 1998 Mar;13(2-3):121-4
9563023
Pediatr Surg Int. 2010 Nov;26(11):1111-5
20721562