Current practice of rectal biopsies for the diagnosis of Hirschsprung’s disease in Latin America: an international online survey
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In brief
In brief
Survey of 149 Latin American pediatric surgeons reveals limited access to rectal suction biopsy (14.1%), with most performing transanal excisional biopsy under general anesthesia for Hirschsprung disease diagnosis. Significant practice variation exists in sample number, biopsy site, and antibiotic use, highlighting need for standardized guidelines.
Written by the GCMD Library team from the article.
Abstract
Purpose
The gold standard for the diagnosis of Hirschsprung’s disease (HD) is a rectal biopsy. The sample may be obtained using a transanal excisional biopsy (TEB) or suction technique. Rectal suction biopsy (RSB) is not a standard procedure in Latin–America.
Aim
To evaluate the current practice in rectal biopsy for HD among pediatric surgeons.
Methods
We distributed an online questionnaire among Latin-American pediatric surgeons.
Results
One hundred forty-nine pediatric surgeons from 15 countries completed the anonymous survey (71.4% of Latin-American countries), grouped into 81.9% pediatric surgeons; 8.9% pediatric colorectal surgeons, 8.9% trainees, and 1 pediatric colorectal surgeon fellow. 50.4% reported less than 5 new patients with HD per year, 36.2% 5–10 new cases, and 13.4% more than 10. Only 14.1% of surgeons have access to perform a RSB in the diagnostic work-up of patients with suspected HD, 90% in our study perform an TEB under general anesthesia. When we ask if they could perform both procedures in babies up to 6 months, 52.3% indicate that they prefer an RSB, and for patients older than 6 months, 35.4% favor an RSB. Regarding the number of samples obtained performing an TEB, 30.9% get one biopsy, 29.5% two biopsies, and 39.6% three or more samples. Surgeons obtained the most proximal biopsy at a median of 2.3 cm (range 1–4 cm) above the pectinate line. 67.8% of surgeons prescribed antibiotic prophylaxis. Overall, 16.1% experienced complications, including rectal blood loss (n = 18), and rectal perforation (n = 3). The most frequently used staining methods for rectal biopsies are hematoxylin/eosin (87%), calretinin (56, 8%), and acetylcholinesterase (21.9%).
Conclusions
In Latin–America, the accessibility for RSB is limited only 18 out of 149 surgeons have access to rectal suction tool. There is no consensus regarding sample number, site of proximal biopsy, and antibiotics use. The complications associated with the procedure seems to be less than reported with RSB. Therefore, we should standardize this common surgical practice and establish universal guidelines for rectal biopsy procedure (RBP).