{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:33:56Z","timestamp":1740126836868,"version":"3.37.3"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"name":"JSPS KAKENHI","award":["No. 20K17593"],"award-info":[{"award-number":["No. 20K17593"]}]},{"DOI":"10.13039\/100012045","name":"Kawano Masanori Memorial Public Interest Incorporated Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012045","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003A biopsy protocol for diagnosing Hirschsprung's disease (HD) in children using the anorectal line (ARL).<\/jats:p><jats:p>\n          Materials and Methods\u2003The ARL was adopted for diagnosing HD in 2016 using two excisional submucosal rectal biopsies performed at different levels, sequentially; the first just above the ARL and the second, further proximal (2-ARL). Currently, only the first-level biopsy is performed (1-ARL) and examined intraoperatively. Management was observation if normoganglionic, pull-through if aganglionic, and a second-level biopsy if hypoganglionic. Hypoganglionosis was considered physiologic if the second-level biopsy was normoganglionic and pathologic if hypoganglionic. Colon caliber change and bowel obstructive symptoms reflect the severity of hypoganglionosis.<\/jats:p><jats:p>\n          Results\u2003For 2-ARL (n\u2009=\u200954), results were: normoganglionosis (n\u2009=\u200931\/54; 57.4%), aganglionosis (n\u2009=\u200919\/54; 35.2%), and hypoganglionosis (n\u2009=\u20094\/54; 7.4%); physiologic (n\u2009=\u20093\/54; 5.6%) and pathologic (n\u2009=\u20091\/54; 1.9%). Normoganglionosis and aganglionosis were always duplicated in 2-ARL (kappa\u2009=\u20091.0). For 1-ARL (n\u2009=\u200936), results were: normoganglionosis (n\u2009=\u200917\/36; 47.2%), aganglionosis (n\u2009=\u200917\/36; 47.2%), and hypoganglionosis (n\u2009=\u20092\/36; 5.6%). Second-level biopsies were normoganglionic (physiologic: n\u2009=\u20091) and hypoganglionic (pathologic: n\u2009=\u20091). All normoganglionic cases, except one, resolved conservatively. All aganglionic cases had pull-through with HD confirmed on histopathology. Both pathologic hypoganglionic cases had caliber change and severe obstructive symptoms as definitive indications for pull-through with hypoganglionosis of the entire rectum confirmed on histopathology. Physiologic hypoganglionic cases were observed and currently have regular defecation.<\/jats:p><jats:p>\n          Conclusion\u2003Because the ARL is an objective functional, neurologic, and anatomic demarcation, normoganglionosis and aganglionosis can be diagnosed accurately with a single excisional biopsy. Only hypoganglionosis requires a second-level biopsy.<\/jats:p>","DOI":"10.1055\/a-2065-9071","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T23:17:10Z","timestamp":1680218230000},"page":"274-281","source":"Crossref","is-referenced-by-count":1,"title":["Biopsy Diagnosis of Hirschsprung's Disease Using a Single Excisional Biopsy Based on the Anorectal Line"],"prefix":"10.1055","volume":"34","author":[{"given":"Masahiro","family":"Takeda","sequence":"additional","affiliation":[{"name":"Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takanori","family":"Ochi","sequence":"additional","affiliation":[{"name":"Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Koga","sequence":"additional","affiliation":[{"name":"Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Tsuboi","sequence":"additional","affiliation":[{"name":"Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Arakawa","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey J.","family":"Lane","sequence":"additional","affiliation":[{"name":"Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 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