Increased Utilization of Abdominal Surgical Procedures, Endoscopy and Imaging After Negative Rectal Biopsies for Suspected Hirschsprung’s Disease: A Danish Nationwide Matched Cohort Study

Objective: Functional constipation affects up to one third of children. When standard treatments fail, the child may be referred to rectal biopsy on the suspicion of Hirschsprung’s disease (HD), but only 7–28% will have a confirmed HD. For those with a negative biopsy for HD, there is limited evidence of the post-biopsy utilization of healthcare services. This study aimed to investigate gastrointestinal-related healthcare utilization after rectal biopsy in non-HD children compared to matched healthy controls and patients diagnosed with HD. Methods: This nationwide registry-based cohort study included all Danish children <18 years who underwent rectal biopsy for HD during the period from 1998 to 2018. The cohort was matched 1:10 to form a control cohort. Outcomes included gastrointestinal surgeries, endoscopies, and imaging procedures pre- and post-biopsy. Results: Among the 1105 children included in the cohort, 128 were diagnosed with Hirschsprung’s disease (HD), while 977 were non-HD. Compared to the control group, the non-HD showed significantly higher rates of post-biopsy surgery (11.2% vs. 1.6%, p < 0.001), endoscopy (9.4% vs. 0.5%, p < 0.001), and imaging (37.1% vs. 7.8%, p < 0.001) related to the gastrointestinal tract. Conclusions: Children with a HD-negative rectal biopsy had 5–10 fold increased frequency of gastrointestinal-related surgeries, endoscopies or imaging during the follow-up period compared to the background population.