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Pediatr Surg Int (2008) 24:715719 DOI 10.1007/s00383-008-2141-9
ORIGINAL ARTICLE
Study of acetylcholinesterase activity in rectal suction biopsy for diagnosis of intestinal dysganglionoses: 17-year experience of a single center
Maria Mercs Santos Uenis Tannuri Maria Ceclia M. Coelho
Accepted: 3 April 2008 / Published online: 12 April 2008 Springer-Verlag 2008
Abstract Although the utility of the acetylcholinesterase (AChE) histochemistry on rectal suction biopsy in diagnosing Hirschsprungs disease (HD) has been documented, few reports address a great number of biopsies and patients. Our aim is to present a 17-year experience on the method of rectal suction biopsy and AChE histochemical staining for diagnosis of intestinal dysganglionoses. Between August 1989 and July 2006, 297 children suspected of having HD were submitted to rectal suction biopsies that were evaluated by the same two surgeons. There were 18 complications (6.0%), namely one self-limited rectal bleeding and 17 (5.7%) inadequate procedures that were repeated. A total of 157 patients (52.8%) showed no increased AChE activity and the remaining patients (14047.2.0%) presented patterns of increased AChE activity conrming the diagnosis of HD or neuronal intestinal dysplasia. Among the 140 cases suspected as having HD, in 131 children the diagnosis of HD was conrmed and they were operated on. The histological studies showed that 111 children presented the classic form of HD or a long spastic segment. Sixteen children presented total colonic aganglionosis and four children proved to have intestinal neuronal dysplasia, according to histological and radiological
criteria. Nine (6.6%) newborns were identied as false-positives and no false-negative results were veried. The rectal suction biopsy combined with AChE staining is advantageous for the differentiation between normal bowel and intestinal dysganglionoses. The rectal suction method is simple and can easily be performed by experienced surgeons. The histological evaluation is very objective and can be performed by a non-pathologist.
Keywords Acetylcholinesterase Rectal suction biopsy Hirschsprungs disease Intestinal neuronal dysplasia Histochemistry Diagnosis
Introduction
Classically, Hirschsprungs disease (HD) may be diagnosed on the basis of radiologic investigations, anorectal manometry and rectal biopsy. Although a barium enema and manometric studies may be highly suggestive, the denitive method for diagnosis is the demonstration of an absence of ganglionic cells in a rectal biopsy specimen.
When Dobbins and Bill [1] reported the efcacy of rectal suction biopsy in 1965,...