De Lorijn F, Reitsma JB, Voskuijl WP, Aronson DC, Ten Kate FJ, Smets AMJB, Taminiau JAJM, Benninga MA. Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests.
J Pediatr 2005;
146:787-92. [PMID:
15973319 DOI:
10.1016/j.jpeds.2005.01.044]
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Abstract
OBJECTIVE
To compare the diagnostic accuracy of contrast enema (CE), anorectal manometry (ARM), and rectal suction biopsy (RSB) for the detection of Hirschsprung's disease (HD).
STUDY DESIGN
Following a prospective protocol, infants suspected of HD underwent all 3 index tests. Children with positive results on 2 or more index tests or who continued to have severe bowel problems underwent a full thickness biopsy as reference standard. Clinical follow-up was the reference standard in all other children.
RESULTS
Between 2000 and 2003, 111 consecutive patients (67 boys; median age, 5.3 months) in whom HD was suspected were enrolled. HD was found in 28 patients. RSB had the highest sensitivity (93%) and specificity (100%) rates, but values were not significantly different from CE (sensitivity, 76%; specificity, 97%) or from ARM (sensitivity, 83%; specificity, 93%). Inconclusive test results occurred in 8 infants with CE, in 15 infants with ARM because of agitation, and in 2 infants with RSB.
CONCLUSION
RSB is the most accurate test for diagnosing HD, and it has the lowest rate of inconclusive test results.
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