Christy Raylan

And our pathologists here, and I'm not sure what's done at your two places, also do a calretinous stain because if the calretinous is present, that means there are ganglion cells nearby. If the calretinous stain is absent, then that further confirms that it's Hirschsprung's disease.

Botox is an interesting subject. I think it's debatable at this point. We have been doing Botox at the time of the pull-through based on Jason's study or his ongoing study. I know there's some literature that suggests that doing it at one month does not prevent enterocolitis.

And you have to be careful about frozens in the setting of inner colitis and basing your decision at that point on a frozen, if you think that there's active inner colitis.

Calretinin staining is used as confirmatory testing: if calretinin is present, ganglion cells are nearby; if calretinin stain is absent, this further confirms Hirschsprung disease.

Calretinin staining is used as an adjunct: if calretinin is present, ganglion cells are nearby; if calretinin stain is absent, this further confirms Hirschsprung disease.

Frozen section interpretation must be done carefully in the setting of active enterocolitis because inflammation can prevent accurate reading of ganglion cells.