Utility of colonic manometry in children with Hirschsprung disease.

OBJECTIVES: Abnormal motility of the residual colon has been reported in post-pull-through Hirschsprung disease (PT-HSCR) patients with persistent defecation problems. We reviewed the role of colonic manometry (CM) in the management of defecation disorders in these patients. METHODS: We retrospectively reviewed the medical record of PT-HSCR children who underwent CM for persistent symptoms of abnormal defecation. We reviewed their clinical course and its relation to CM findings. RESULTS: Thirty PT-HSCR patients underwent CM, of which five were diagnosed with transition zone pull-through and were excluded. Of the remaining 25 patients, 16 had colonic dysmotility, 8 had normal CM, and one had colonic hypermotility. In patients with dysmotility, five responded to ongoing medical management, three required surgical intervention (ileostomy), three remained symptomatic with medical management but not yet received surgical intervention, and five were lost to follow-up. In patients with normal CM, four responded to ongoing medical therapy, two required additional surgery (antegrade enema procedure), and two were lost to follow-up. The patient with hypermotility improved with adding loperamide. CONCLUSIONS: Colonic dysmotility can occur in PT-HSCR patients with persistent defecation problems. CM was helpful in delineating the degree of colonic neuromuscular dysfunction. CM results were used in conjunction with other clinical data to determine optimal management. Our findings support that medical management should first be optimized before consideration of colonic manometry and surgical interventions.

Comparison of Diagnostic Accuracy and Concordance of Video Capsule Endoscopy and Double Balloon Enteroscopy in Children.

OBJECTIVES: To compare the diagnostic yield, sensitivity, and specificity of video capsule endoscopy (VCE) with double balloon enteroscopy (DBE), including comparison with histological findings as well as degree of concordance of the studies. METHODS: Retrospective review of pediatric patients who had DBE following VCE at a single center from 2006 to 2013. VCEs were interpreted by 1 of 4 pediatric gastroenterologists and DBEs were performed by a single endoscopist. RESULTS: Thirty-six patients ranging from 5 to 20 years had DBE following VCE. There were positive findings in 32 (88.8%) of VCE and 21 (58.3%) of DBE. Significant histological findings were identified in 16 patients (44.4%). When comparing VCE with DBE findings, VCE had a sensitivity of 95% and specificity of 20%. Overall concordance between VCE and DBE findings was weak with calculated kappa index of 0.1702; however, this varied widely by indication. VCE had sensitivity 100% and specificity 20% for detecting histologically significant lesions. DBE had sensitivity of 87% and specificity of 65%. CONCLUSIONS: This is the first pediatric study to evaluate diagnostic accuracy and concordance of VCE and DBE and to compare both to histological findings. Our study supports the high diagnostic utility of both the studies. VCE is highly sensitive with an excellent negative predictive value both for DBE findings and for histological findings; however, the utility of VCE is limited by low specificity. Sensitivity and specificity of DBE for detecting histologically significant findings were good. Overall agreement between VCE and DBE is low but varies by indication for the study. These results support the use of VCE and DBE as complementary studies.