Barium Enema Revisited in the Workup for the Diagnosis of Hirschsprung's Disease

Lourenção, Pedro Luiz Toledo de Arruda; Valerini, Felipe Gilberto; Catâneo, Antônio José Maria; Ortolan, Érika Veruska Paiva; Silveira, Guilherme Lopes da; Piva, Mariana Floriano Luiza; Cucco, Lucas da Matta; Rodrigues, Maria Aparecida Marchesan

doi:10.1097/mpg.0000000000002242

Cited by 9 publications

(7 citation statements)

References 19 publications

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“…When the whole colon and rectum are aganglionic and spasmodic, rectal ampulla may be di cult to identfy in barium enema, even for experienced radiologists. Transition zone is regarded as an effective radiographic sign to identify the extent of aganglionic bowel in "segmental" HD and could therefore facilitate surgical planning [21]. In our study, the two radiologists noted these occurrences in 12 (12/44, 27%) and 26 (26/44, 59%) patients, and both of these values were higher than that reported in a previous study of TCA (2/17, 12%) [7].…”

Section: Discussioncontrasting

confidence: 55%

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Barium enema findings in total colonic aganglionosis: a single-center, retrospective study

Yan

Sun

et al. 2020

Preprint

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Background Preoperative diagnosis of total colonic aganglionosis is important for the rational choice of treatment. The present study aimed to evaluate the diagnostic performance of radiographic signs on preoperative barium enema in patients with total colonic aganglionosis. Methods Forty-four patients [41 (3-659) days] with total colonic aganglionosis, including 17 neonatal patients, who received preoperative barium enema at our center, from January 2007 to December 2019 were included. All radiographs were retrospectively restudied by 2 pediatric radiologists to ascertain radiographic signs including rectosigmoid index, transition zone, irregular contraction, gas-filled small bowel, microcolon, question-mark-shaped colon and ileocecal valve reflux. Kappa test was performed to assess the accuracy and consistency of the radiographic signs. Results The 2 radiologists showed slight agreement for gas-filled small bowel, microcolon and rectosigmoid index, fair agreement for transition zone and irregular contraction, and moderate agreement for question-mark-shaped colon and ileocecal valve reflux (Kappa values, 0.043, 0.075, 0.103, 0.244, 0.397, 0.458 and 0.545, respectively). In neonatal patients, the 2 radiologists showed moderate agreement for ileocecal valve reflux and substantial agreement for question-mark-shaped colon (Kappa values, 0.469 and 0.667, respectively). In non-neonatal patients, the 2 radiologists showed substantial agreement for ileocecal valve reflux (Kappa value, 0.628). In 36 patients with total colonic aganglionosis extending to the ileum, the accuracies of question-mark-shaped colon, ileocecal valve reflux and the combination of both were 47%, 53%, and 75%, respectively, in one radiologist and 53%, 50% and 72%, respectively, in the other. Conclusion Ileocecal valve reflux was a reliable radiographic sign for diagnosing total colonic aganglionosis and could improve the accuracy by combination with question-mark-shaped colon.

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Section: Discussioncontrasting

confidence: 55%

“…However, there are still some problems associated with water-soluble contrast; these include the risk of dehydration and a lack of research [20]. Barium enema is still the most widely used method for diagnosing TCA in most centers [19,21].…”

Section: Introductionmentioning

confidence: 99%

Barium enema findings in total colonic aganglionosis: a single-center, retrospective study

Yan

Sun

et al. 2020

Preprint

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“…9 The aganglionic segment is due to failure of migration of neural crest cells (precursors of enteric ganglion cells) during organogenesia. 15 The diagnosis of HD is usually based on a combination of the presenting symptoms, radiological studies, rectal manometry and histological features of rectal biopsy. 16…”

Section: Discussionmentioning

confidence: 99%

Comparative study between use of calretinin and synaptophysin immunostaining in diagnosis of Hirschsprung disease

et al. 2019

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Background: Hirschsprung disease (HD) is diagnosed by absence of ganglion cells in rectal biopsy. In some cases, standard methods fail to diagnose agangliosis. The aim of this study is to assess the diagnostic value of immunohistochemistry (IHC) of calretinin and synaptophysin compared to standard methods.Methods: This prospective cross section study was conducted in Menoufia University hospitals, Egypt spanning the period between October 2017 to December 2018. Rectal biopsies of the clinically suspected HD patients stained with calretinin and synaptophysin and their results compared to the standard hematoxylin and eosin (H&E) stained sections.Results: A total of 30 patients aged from 3 days to 2 years with a male to female ratio 11:4 were examined for rectal biopsies. Sections of 9 cases were diagnosed HD. In inadequate specimens, sensitivity and specificity of calretinin and synpatophysin (100%, 80%) and (100%, 85.71%) respectively were superior to the sensitivity (40%) and specificity (14%) of H&E. However, in adequate specimens, results of H&E, calretinin and synaptophysin were the same.Conclusions: Immunohistochemical expression of calretinin and synaptophysin were conclusive, diagnostic and superior to the results of H&E stained section in inadequate. However, in adequate specimens calretinin and synaptophysin were consistent and confirmatory to the results of H&E sections.

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“…Different radiologists may choose different radiographs to record rectosigmoid index ≤ 1 in a patient, which would influence judgment. Transition zone is regarded as an effective radiographic sign to identify the extent of aganglionic bowel in “segmental” HD and could therefore facilitate surgical planning [ 21 ]. In our study, the two radiologists noted these occurrences in 12 (12/44, 27%) and 26 (26/44, 59%) patients, and both of these values were higher than that reported in a previous study of TCA (2/17, 12%) [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, some problems are associated with water-soluble contrast, including the risk of dehydration and a lack of research [ 20 ]. Barium enema remains the most widely used method for diagnosing TCA in most centers [ 19 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Barium enema findings in total colonic aganglionosis: a single-center, retrospective study

Yan

Sun

et al. 2020

BMC Pediatr

View full text Add to dashboard Cite

Background Preoperative diagnosis of total colonic aganglionosis is important for the rational choice of treatment. The present study aimed to evaluate the diagnostic performance of radiographic signs on preoperative barium enema in patients with total colonic aganglionosis. Methods Forty-four patients [41 (3-659) days] with total colonic aganglionosis, including 17 neonatal patients, who received preoperative barium enema at Beijing Children’s Hospital, from January 2007 to December 2019 were included. All radiographs were retrospectively restudied by 2 pediatric radiologists to ascertain radiographic signs including rectosigmoid index, transition zone, irregular contraction, gas-filled small bowel, microcolon, question-mark-shaped colon and ileocecal valve reflux. Kappa test was performed to assess the accuracy and consistency of the radiographic signs. Results The 2 radiologists showed slight agreement for gas-filled small bowel, microcolon and rectosigmoid index, fair agreement for transition zone and irregular contraction, and moderate agreement for question-mark-shaped colon and ileocecal valve reflux (Kappa values, 0.043, 0.075, 0.103, 0.244, 0.397, 0.458 and 0.545, respectively). In neonatal patients, the 2 radiologists showed moderate agreement for ileocecal valve reflux and substantial agreement for question-mark-shaped colon (Kappa values, 0.469 and 0.667, respectively). In non-neonatal patients, the 2 radiologists showed substantial agreement for ileocecal valve reflux (Kappa value, 0.628). In 36 patients with total colonic aganglionosis extending to the ileum, the accuracies of question-mark-shaped colon, ileocecal valve reflux and the combination of both were 47%, 53%, and 75%, respectively, in one radiologist and 53%, 50% and 72%, respectively, in the other radiologist. Conclusions Ileocecal valve reflux is a relatively reliable radiographic sign for diagnosing total colonic aganglionosis and could improve the diagnostic accuracy upon combination with question-mark-shaped colon.

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Barium Enema Revisited in the Workup for the Diagnosis of Hirschsprung's Disease

Cited by 9 publications

References 19 publications

Barium enema findings in total colonic aganglionosis: a single-center, retrospective study

Barium enema findings in total colonic aganglionosis: a single-center, retrospective study

Comparative study between use of calretinin and synaptophysin immunostaining in diagnosis of Hirschsprung disease

Barium enema findings in total colonic aganglionosis: a single-center, retrospective study

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