Article
Contrast enema for Hirschsprung disease investigation: diagnostic accuracy and validity for subsequent diagnostic and surgical planning
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Published: | April 24, 2015 |
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Introduction: To evaluate the diagnostic accuracy of contrast enema (CE) for Hirschsprung disease (HD) diagnosis and to compare two diagnostic approaches with different chronological orders between rectal biopsy (RB) and CE.
Material and methods: Retrospective observational study of children undergoing RB for HD investigation. Of the CE the occurrence and level of a radiological transition zone (rTZ) were recorded and the rectosigmoid index (RSI) calculated. The concordance between the rTZ in the CE and histological transition zone (hTZ) assessed by RB were studied. Odds-ratios for various predictors were determined.
Results: 107 cases were included. Sensitivity and specificity for CE and RSI were 74.1% and 94.6% vs. 77.8% and 75% respectively. A rTZ present in CE was associated with a 50-fold increased probability for HD. The overall concordance between rTZ and hTZ was high (kappa 0.642, p=0.003).
Within the rectosigmoid a rTZ predicts the hTZ correctly in 94.4% of cases but only in 50% of cases in the proximal segments. By performing a CE only after HD diagnosis confirmation by RB would avoid 67.5% of CE with no loss of diagnostic accuracy.
Conclusion: We confirm that CE should only be performed for subsequentdiagnostic and surgical planning following histological confirmation of HD by RB. Based on this, an algorithm for optimized investigation and management of HD is presented.