Comparing Rectal Biopsy Using Artery Forceps And Full-Thickness Rectal Biopsy In Diagnosing Hirschsprung’s Disease At University Teaching Hospital, Lusaka

  • Grainer Chizoma University Teaching Hospital, Department of Surgery, Paediatric and Neonatal Surgical unit, P/B RW1X, Lusaka, Zambia
  • Bruce Bvulani University Teaching Hospital, Department of Surgery, Paediatric and Neonatal Surgical unit, P/B RW1X, Lusaka, Zambia
  • Penius Tembo University Teaching Hospital, Department of Surgery, Paediatric and Neonatal Surgical unit, P/B RW1X, Lusaka, Zambia
Keywords: Hirschsprung’s disease, full-thickness biopsy, superficial-thickness biopsy, curved artery forceps


Hirschprung’s disease is a congenital disorder characterised by functional constipation whose onset is dependent on the length of the affected bowel and always involves the rectum. Rectal biopsy for histological analysis is the most definitive form of diagnosis. Full-thickness biopsy, which involves full wall laceration under general anaesthesia, continues to be commonly practiced in many African countries, including Zambia. Rectal suction biopsy, which can obtain a superficial-thickness biopsy as deep as the submucosa, has been adopted as the gold standard in the western world, leaving the invasive full-thickness biopsy with its associated risks for inconclusive cases. However, different types of forceps using the grasp and cut method have been shown to be able to obtain superficial-thickness biopsies that are as good or even superior to the rectal suction biopsy. The medium curved artery forceps was proposed to provide a simple, less invasive and hopefully cost-effective method of obtaining superficial rectal biopsies. Thirty-one (31) patients were enrolled in a prospective, single-blind study that was conducted at the University Teaching Hospital in the Department of Surgery, Paediatric Surgical unit from 2018 to 2019. Two biopsy specimens were obtained from each patient in the same sitting using the full-thickness biopsy method and artery forceps and compared the results. Out of 31 patients, 19 (61.30%) of the full-thickness biopsy specimens were adequate for diagnosis, whereas only 4 (12.9%) of the superficial-thickness biopsy specimens using curved artery forceps were adequate. The biopsy obtained using the curved artery forceps had a high sensitivity (93.3%) and poor specificity (13.3%), and predictive value. Although not all patients required suturing hence saving on consumables, none of the patients developed any complications during or after the procedures. Based on these results, the medium curved artery forceps is a poor choice for obtaining rectal biopsies. The traditional full-thickness biopsy procedure should be continued. Efforts should be made to acquire the necessary tools to obtain superficial thickness biopsy and reserve full-thickness biopsy for indeterminate cases.


1. Ax SÖB, Arnbjörnsson E, Gisselsson-Nord D. A Comparison of Rectal Suction and Full Wall Biopsy in Hirschsprung’s Disease. Surgical Science. 2014;05(01):15–9. Available from:
2. Abdur-Rahman LO, Cameron BH. Hirschsprung’s Disease in Africa in the 21st Century. University of Toronto Libraries; 2011. Available from:'s%20Disease.pdf
3. De Lorijn F, Kremer LCM, Reitsma JB, Benninga MA. Diagnostic tests in Hirschsprung disease: a systematic review. J Pediatr Gastroenterol Nutr 2006; 42(5): 496–505.
4. Spataru R-lulian, Bratu N, Ivanov M, Iozs D-A. A seven-year experience in Hirschsprung's disease treatment. J. Pediatric. 2014;17:65–6.
5. Monajemzadeh M, Kalantari M, Yaghmai B, Shekarchi R, Mahjoub F, Mehdizadeh M. Hirschsprung's Disease: a Clinical and Pathologic Study in Iranian Constipated Children. Iran J. Pediatri. 2011; 21(3): 362–366
6. Rahman Z, Hannan J, Islam S. Hirchsprung’s disease: role of rectal suction biopsy-data on 216 specimens. J. Indian Assoc. Pediatric. Surg. 2010; 15(2): 56–58.
7. Marei MM, Abdelsattar AH, Yassin TM, Fares AE, Elsaket H, Seif H et al. Reducing the frequency of unnecessary rectal biopsies by combined interpretation of clinical and radiological findings in Egyptian children with suspected Hirschsprung’s disease. Gaz Egypt Paediatric. Assoc. 2015; 63:80-85
8. Bjørn, N., Rasmussen, L., Qvist, N., Detlefsen, S., Ellebæk, M. B. Full-thickness rectal biopsy in children suspicious for Hirschsprung's disease is safe and yields a low number of insufficient biopsies. J. Paediatric Surg. 2018; 53 (10): 1942–1944.
9. Nasir, A.A, Ameh, E.A. A survey of current practices in management of Hirschsprung's disease in Nigeria. Afr. J. Paediatric Surg. 2014; 11(2): 114-118.
10. Bamigbola KT, Nasir AA, Abdur-Rahman LO, Oyinloye AO, Abdulraheem NT, Adeniran JO. Experience with full-thickness rectal biopsy in the evaluation of patients with suspected Hirschsprung’s disease. Annals Paediatric Surg. 2014; 10 (2): 42–5.
12. Brady A-C, Saito MJ, Lukas K, Guthrie T, Utterson CE, White VF et al. Suction rectal biopsy yields adequate tissue in children. J. Paediatric Surg. 2016; 51: 966–969.
11. Croffie JM, Davis MM, Faught PR, Corkins MR, Gupta SK, Pfefferkorn MD, et al. At what age is a suction rectal biopsy less likely to provide adequate tissue for identification of ganglion cells? J. Paediatric Gastroenterol Nutr. 2007; 44 (2): 198–202.
13. Hirsch BZ, Angelides AG, Goode SP, Garb JL. Rectal biopsies obtained with jumbo biopsy forceps in the evaluation of Hirschsprung disease. J. Paediatric Gastroenterol Nutr. 2011; 52(4): 429–432
12. Huang C-C, Shih S-L, Chen Y-F, Yang F-S. Hirschsprung Disease and Contrast Enema: Diagnostic Value of Simplified Contrast Enema and Twenty-Four-Hour-Delayed Abdominal Radiographs. J. Radiol. Sci. 2011; 36(3): 16–21.
13. Martucciello G, Pini Prato A, Puri P, Holschneider AM, Meier-Ruge W, Jasonni V, et al. Controversies concerning diagnostic guidelines for anomalies of the enteric nervous system: a report from the fourth International Symposium on Hirschsprung's disease and related neurocristopathies. J. Pediatric Surg. 2005;40 (10):1527-1531.
14. Gupta P, Sakhi P, Nagar A, Julka K, Singh S, Gupta M. A Prospective Observational Study to Evaluate the Cases of Suspicious Hirschsprung’s Disease in Neonates and Children Using Radiologic Investigation Method. JMSCR 2017; 05 (09):27612-27623.
15. Muise ED, Cowles RA. Rectal biopsy for Hirschsprung's disease: a review of techniques, pathology, and complications. World J. Pediatric. 2016; 12(2): 135-141
16. Rbi2 instructions for use manufactured by Aus Systems Pty Ltd. Victor, MT: Specialty Surgical Products, Inc.; 2010.
How to Cite
Chizoma G, Bvulani B, Tembo P. Comparing Rectal Biopsy Using Artery Forceps And Full-Thickness Rectal Biopsy In Diagnosing Hirschsprung’s Disease At University Teaching Hospital, Lusaka. University of Zambia Journal of Agricultural and Biomedical Sciences [Internet]. 16Dec.2021 [cited 28May2022];5(2). Available from:
Biomedical Sciences