Hirschsprung disease (HD) is diagnosed through histological examination of rectal biopsies. The purpose of this review is to identify the best rectal biopsy procedure. This study included a systematic assessment of the literature and a proportionate meta-analysis of the available case series studies of rectal biopsies. All case series involving more than five rectal biopsies in children under the age of 18 suspected of having HD and describing at least one type of rectal biopsy were included.
Rectal biopsy was performed using four different procedures, according to the literature review: open, suction, punch, and endoscopic. The study evaluated 496 publications throughout the title and abstract screening procedure; 159 met the eligibility requirements, and 71 studies reported our outcomes of interest and were included in the meta-analysis. The pooled proportion of decisive results in open biopsies was 94 percent, 95 percent in punch biopsies, and 88 percent in suction biopsies. The pooled proportion of complication rates in open biopsies was 2%, 0.039 percent in suction biopsies, and 2% in punch biopsies. The frequencies of decisive outcomes for suction, punch, and open procedures were comparable. The link between different methods of histological examination enhanced the rate of conclusive results in the suction group; however, the punch biopsy was associated with much greater complication rates than the suction technique.