Bleeding after suction rectal biopsy with Rbi2: identification of the root cause through a multi-staged approach

Corbett, Harriet J, Jeeneea, Ramanand and Hennessey, Iain (2021) Bleeding after suction rectal biopsy with Rbi2: identification of the root cause through a multi-staged approach. WORLD JOURNAL OF PEDIATRIC SURGERY, 4 (4). e000319-.

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Official URL: http://dx.doi.org/10.1136/wjps-2021-000319

Abstract

<h4>Introduction</h4>Suction rectal biopsy (SRB) is a key diagnostic tool in Hirschsprung's disease. The original Noblett device has been superseded by modern alternatives including the Rbi2 rectal biopsy gun. We describe a comparison of biopsy results from the Noblett device and the Rbi2 gun and an investigation into significant post-biopsy bleeding episodes with the latter.<h4>Methods</h4>A retrospective review of SRB episodes between 2006 and 2014 was undertaken to audit biopsy success rates. Significant post-procedure bleeding after SRB with the Rbi2 gun prompted further investigations.<h4>Results</h4>Biopsies taken with the Noblett gun were more likely to be inadequate (Noblett 82/197 (40%) vs Rbi2 77/438 (18%)). After biopsy with the Rbi2 gun, 2 infants suffered from significant bleeding requiring resuscitation, blood product support and multiple theater episodes. As there were no reported cases of bleeding with the Rbi2 gun, a report was made to the Medicines & Healthcare products Regulatory Agency who identified incorrect biopsy technique as a potential contributing factor. A questionnaire of trainees and consultants found unexpected individual variation in SRB technique, with some users applying excessive suction.<h4>Conclusions</h4>Significant bleeding occurred after SRB with the Rbi2 gun, excessive suction was thought to be the cause.

Item Type:	Article
Uncontrolled Keywords:	pediatrics
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences > School of Medicine
Depositing User:	Symplectic Admin
Date Deposited:	15 Dec 2023 10:27
Last Modified:	15 Dec 2023 10:28
DOI:	10.1136/wjps-2021-000319
Open Access URL:	http://10.0.4.112/wjps-2021-000319
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3177408