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2010, Number 3

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Rev Mex Cir Pediatr 2010; 17 (3)

Utility of anorectal manometry as a diagnostic test in Hirschsprung disease

Nieto-Zermeño J, Dávila-Pérez R, Tovilla-Mercado JM, Bracho-Blanchet E, Herappe-Mellado D

Language: Spanish
References: 42
Page: 127-143
PDF size: 589.12 Kb.


ABSTRACT

Introduction: Hirschsprung’s disease (HD) is characterized by absence of ganglion cells (GC) in a variable length of the colon. The gold standard diagnosis of EH is the full thickness rectal biopsy, although some authors consider the suction biopsy as the gold standard (consensus 2005). Anorectal manometry (MAN) is a noninvasive procedure that demonstrates the absence of rectoanal inhibitory reflex (IIRR) in the cases of HD. In recent publications are regarded MAN no diagnostic value in HD.
Material and Methods: A retrospective, observational, included all pediatric patients with suspected HD and counted with MAN and the diagnostic gold standard for our hospital (total thickness colorectal biopsies) from 1984-2008. 2x2 tables are made between the result of man vs. the result of the biopsy (gold standard) to determine the real value of the MAN as a diagnostic test (sensitivity, specificity, positive predictive value and negative, false positive and negative).
Results: Of a total of 455 MAN performed in our hospital from 1984 to 2008, 267 were in patients in our hospital and the rest were external consults. Of these 267 MAN, 79 counted gold standard diagnosis (intestinal biopsy), 55 and 24 did not show whether IIRR IIRR showed, the first in 52 found the absence of ganglion cells confirming the diagnosis of EH, was observed in 3 ruling out the presence of ganglion cells of HD. Of the second 24 (presence of IIRR), 100% showed presence of ganglion cells in the histological study discarding EH. In no patient of the latter group showed absence of ganglion cells in the histological study.
The MAN as a diagnostic test comprehensively demonstrates a sensitivity of 100%, specificity 88%, positive predictive value of 94% and negative predictive value 100%, and 5.4% false positive and false negative 0% compared with the standard gold. By grouping patients under and over two years are: children under 2 years showed that the MAN has a sensitivity of 100%, specificity 81%, 91% positive predictive value, negative predictive value 100%, 3 false positives and no false negatives, and over 2 years showed a sensitivity of 100%, specificity 100%, 100% positive predictive value, negative predictive value 100%, and no false positive nor negative.
Discussion: MAN in our experience is a key diagnostic pillar to help confirm EH with high sensitivity and specificity but also because of its ability to rule by EH negative predictive value 100%, the above is particularly noticeable in older patients 2 years.
Although the diagnostic gold standard in our hospital continues to be the full thickness intestinal biopsy because of the advantages offered by the MAN (less invasiveness, ease of implementation, and extensive experience in our department), the latter maintains a dominant role in the diagnosis EH, it is worth mentioning that the man in our hospital has been conducted in a standardized manner since 1984 and in 95% of the cases is done by the same staff, which gives a margin of safety to the test very high since technical standpoint.
In our study is very important to note that compared to the MAN in 100% of the cases against the diagnostic gold standard and our 2x2 table is perfectly reproducible, which is considered vital in the meta-analysis impartancia giving an important validity to our study


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