Paediatric Colorectal and Pelvic Reconstruction Centre, Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, South Africa.
Department of Anatomical Pathology, University of the Witwatersrand, South Africa and Chris Hani Baragwanath Laboratory, National Health Laboratory Services, South Africa.
S Afr J Surg. 2023 Jun;61(2):96-99. doi: 10.36303/SAJS.3913.
The diagnosis of Hirschsprung's disease (HD) by rectal suction biopsy (RSB) has cost implications that could be reduced by ascertaining the optimal number of specimens required. The aim was to audit our experience to optimise cost-effectiveness.
Medical records of all patients who underwent an RSB between January 2018 and December 2021 were reviewed. In 2020, we transitioned from using the Solo-RBT to the rbi2 system (requiring single-use cartridges). Descriptive statistics were reported and a comparative analysis of the diagnostic efficacy of the Solo-RBT versus the rbi2 system was performed. The cost of consumables was calculated according to the number of specimens submitted.
Of 218 RSBs, 181 were first and 37 were repeat. The mean age at biopsy was 62 days (IQR 22-65). An average of two tissue specimens were obtained per biopsy. Of the 181 first biopsies, 151 were optimal and 30 suboptimal. HD was confirmed in 19 (10.5%) of the patients. Amongst biopsies where a single specimen was obtained, 16% were inconclusive, compared to 14% with two specimens and 5% with three specimens. The cartridges for the rbi2 system cost R530. If two cartridges are used at initial biopsy the total cost is double of a single tissue specimen sent for initial biopsy, and two specimens sent for repeat biopsies.
In a low-resource setting, selecting the appropriate RSB system and obtaining a single specimen is sufficient to diagnose HD. Patients with inconclusive results should undergo a repeat biopsy where two specimens are obtained.
经直肠吸引活检（RSB）诊断先天性巨结肠症（HD）会产生成本，通过确定所需的最佳标本数量可以降低成本。目的是审查我们的经验以优化成本效益。
回顾了 2018 年 1 月至 2021 年 12 月期间所有接受 RSB 的患者的病历。2020 年，我们从使用 Solo-RBT 过渡到 rbi2 系统（需要一次性使用的试剂盒）。报告了描述性统计数据，并对 Solo-RBT 与 rbi2 系统的诊断效果进行了比较分析。根据提交的标本数量计算了耗材的成本。
218 例 RSB 中，181 例为初次活检，37 例为重复活检。活检时的平均年龄为 62 天（IQR 22-65）。平均每次活检获得两个组织标本。在 181 例初次活检中，151 例为最佳，30 例为次佳。19 例（10.5%）患者确诊为 HD。在获得单个标本的活检中，16%的结果不确定，而获得两个标本的活检中为 14%，获得三个标本的活检中为 5%。rbi2 系统的试剂盒成本为 530 兰特。如果在初次活检时使用两个试剂盒，则总费用是单次送检单个组织标本的两倍，而两次送检两个标本的费用则与单次送检两个标本相同。
在资源有限的情况下，选择合适的 RSB 系统并获得单个标本足以诊断 HD。结果不确定的患者应进行重复活检，获得两个标本。
