Accuracy of transition zone in contrast enema to predict intraoperative aganglionosis level in patients with Hirschsprung disease

Objective: While frozen section methods have been widely conducted to determine aganglionosis segment during transanal endorectal pull-through (TEPT) for Hirschsprung disease (HSCR) patients in most institutions, some hospitals still rely on contrast enema to predict aganglionosis segments due to unavailability of frozen section facilities. We determined the accuracy of transition zone in contrast enema to predict aganglionosis segments during TEPT. We retrospectively reviewed all contrast enema and frozen sections for HSCR patients under 2 years of age who underwent TEPT at our institution. Results: We recruited 36 HSCR patients: Twenty-six patients (72.2) had radiographic transition zones limited to rectum, while ten subjects (27.8) were limited to rectosigmoid. The rectum subgroup of patients showed a concordance of 30.8, whereas the rectosigmoid subgroup had a concordance of 100. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of contrast enema compared with intraoperative histopathological findings for aganglionosis level were 100 (95 CI 0.60-1.0), 35.7 (95 CI 0.19-0.56), 30.8 (95 CI 0.15-0.52), 100 (95 CI 0.66-1.0), and 50 (95 CI 0.33-0.67), respectively. In conclusions, contrast enema has low accuracy to predict intraoperative aganglionosis segments in HSCR patients, indicating that it might not be utilized to determine aganglionosis level during TEPT.