Different Rectal Biopsy Techniques for Hirschsprung Disease

Infographic · May 2021 · 1 min read

In brief

Systematic review comparing four rectal biopsy techniques for diagnosing Hirschsprung disease found suction, punch, and open methods yielded similar diagnostic accuracy (88-95%), but suction biopsy had significantly lower complication rates (0.039%) compared to punch (2%) and open techniques (2%).

Suction, punch, and open rectal biopsy techniques all achieve ~88-95% conclusive results for Hirschsprung disease diagnosis.
Suction biopsy has the lowest complication rate (0.039%) compared to punch and open techniques (both ~2%).
Combining multiple histopathological analysis methods with suction biopsy increases diagnostic accuracy.
Punch biopsy carries significantly higher complication risk than suction technique despite similar diagnostic yield.
Rectal biopsy remains the gold standard for HD diagnosis; technique choice should balance diagnostic yield with safety profile.

Written by the GCMD Library team from the infographic.

The infographic uses a clean layout with a red header banner and three columns showing anatomical illustrations of different biopsy techniques (open, punch, and suction). A colon diagram with red arrow indicates biopsy site. Success rates are shown in large gray percentages, while complication rates appear below, with the suction technique's notably low rate highlighted in red. Study metadata and patient numbers appear on the left side.

Abstract

The diagnosis of Hirschsprung disease (HD) depends on the histopathological analysis of rectal biopsies. This review aims to define the best rectal biopsy technique. A systematic literature review and proportional meta-analysis of the available case series studies of rectal biopsies were performed in this study. All case series with more than five rectal biopsies in children younger than 18 years of age suspected of HD that described at least one type of rectal biopsy were included. The studies that did not specify the rate of conclusive results and the rate of complications of the biopsy procedures were excluded. According to the literature review, there were four different techniques of rectal biopsy: open, suction, punch, and endoscopic. In the title and abstract screening process, we assessed 496 articles, 159 fulfilled the eligibility criteria, and 71 studies reported our outcomes of interest and were included in the meta-analysis. The pooled proportion of conclusive results was 94% in open biopsies (95% CI 0.89-0.98), 95% in punch (95% CI 0.90-0.98), and 88% in suction group (95% CI 0.85-0.92). The pooled proportion of complication rates was 2% in open biopsies (95% CI 0.00031-0.04), 0.039% in suction (95% CI 0.00023-0.0006), and 2% in punch biopsies (95% CI 0.00075-0.04). Suction, punch, and open techniques presented comparable rates of conclusive results. In the suction group, the association between different methods of histopathological analysis increased conclusive results rates; however, the punch biopsy was associated with significantly higher complication rates than the suction technique.

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