Comparing Rectal Biopsy Using Artery Forceps And Full-Thickness Rectal Biopsy In Diagnosing Hirschsprung’s Disease At University Teaching Hospital, Lusaka

Abstract

Hirschprung’s disease is a congenital disorder characterised by functional constipation whose onset is dependent on the length of the affected bowel and always involves the rectum. Rectal biopsy for histological analysis is the most definitive form of diagnosis. Full-thickness biopsy, which involves full wall laceration under general anaesthesia, continues to be commonly practiced in many African countries, including Zambia. Rectal suction biopsy, which can obtain a superficial-thickness biopsy as deep as the submucosa, has been adopted as the gold standard in the western world, leaving the invasive full-thickness biopsy with its associated risks for inconclusive cases. However, different types of forceps using the grasp and cut method have been shown to be able to obtain superficial-thickness biopsies that are as good or even superior to the rectal suction biopsy. The medium curved artery forceps was proposed to provide a simple, less invasive and hopefully cost-effective method of obtaining superficial rectal biopsies. Thirty-one (31) patients were enrolled in a prospective, single-blind study that was conducted at the University Teaching Hospital in the Department of Surgery, Paediatric Surgical unit from 2018 to 2019. Two biopsy specimens were obtained from each patient in the same sitting using the full-thickness biopsy method and artery forceps and compared the results. Out of 31 patients, 19 (61.30%) of the full-thickness biopsy specimens were adequate for diagnosis, whereas only 4 (12.9%) of the superficial-thickness biopsy specimens using curved artery forceps were adequate. The biopsy obtained using the curved artery forceps had a high sensitivity (93.3%) and poor specificity (13.3%), and predictive value. Although not all patients required suturing hence saving on consumables, none of the patients developed any complications during or after the procedures. Based on these results, the medium curved artery forceps is a poor choice for obtaining rectal biopsies. The traditional full-thickness biopsy procedure should be continued. Efforts should be made to acquire the necessary tools to obtain superficial thickness biopsy and reserve full-thickness biopsy for indeterminate cases.