Endoscopic Mucosal Resection is Superior to Rectal Suction Biopsy for Analysis of Enteric Ganglia in Constipation and Dysmotility.

Patients with chronic constipation or motility disorders may be referred for rectal suction biopsy (RSB) to rule out Hirschsprung's disease (HD). RSB may not be successful beyond infancy due to the increased thickness of rectal mucosa. Endoscopic mucosal resection (EMR) could improve the diagnostic yield for HD when compared with traditional RSB because of the larger and deeper samples acquired for analysis.In this prospective, single-center study, patients referred for RSB were offered enrollment for concurrent EMR. Specimens were analyzed pathologically for size, submucosal ganglionic tissue, and acetylcholinesterase or calretinin staining. Biopsy results were compared with transit studies, anorectal manometry, and constipation severity through validated questionnaires.Seventeen patients (2 male, 15 female, mean age 35.8 years, range 22-61 years) were enrolled in the study from 2008 to 2014. All subjects underwent anorectal manometry (88% with anorectal dysfunction, 68% with outlet obstruction) and transit studies (41% with delayed transit). There were no reports of adverse events from the RSB and EMR procedures. The RSB sample volumes were significantly lower than EMR samples (0.023 cm(3) vs 0.26 cm(3), p=0.001). There was diagnostic tissue for submucosal visualization by RSB in 53% (9/17) of cases compared with 100% (17/17) with EMR (p=0.003). No cases of HD were diagnosed by RSB; one patient had rare ganglions observed by EMR.EMR provides greater tissue volumes and can improve the characterization of ganglion cells in rectal tissue compared with RSB in patients with moderate to severe constipation with suspected HD.