Abstract Suction rectal biopsy (SRB) may not in- clude sufficient submucosa for histological diagnosis of Hirschsprung’s disease (HD) and a repeat biopsy is required. Substitution of the conventional syringe for sustained suction from a machine or wall suction unit could provide a more consistently adequate tissue biopsy. This study was conducted to compare the adequacy of SRB specimens using a conventional method of syringe suction (SSRB) with those taken by wall or machine suction (WSRB). Hospital records of patients who had a SRB between 2002 and 2004 were studied retrospectively. The biopsy was considered inadequate if there was insufficient submucosa and a repeat specimen was requested. SSRB were taken using the conventional SSRB technique. WSRB were taken with the same Noblett forceps but with suction from wall suction or from a portable suction machine. Ninety-five infants had 103 SRB, 24 had WSRB and all (100%) were adequate for histopathological diagnosis or exclusion of HD. Seventy nine conventional SSRB were undertaken in 71 infants of which 64 (81.02%) were adequate. The difference in adequacy between WSRB and SSRB was statistically significant (P = 0.02). There were no instances of haemorrhage or bowel perforation in either subgroup. WSRB with the Noblett biopsy forceps is more likely to produce an adequate specimen and to reduce the incidence of re- peat biopsies. Keywords Hirschsprung’s disease Æ Suction rectal biopsy Introduction Rectal mucosal suction biopsy (SRB) is usually suc- cessful for the diagnosis of Hirschsprung’s disease (HD) in the neonates and infants. However, the biopsy specimen may not include sufficient submucosa for histological assessment and a deeper repeat biopsy under general anaesthesia is then necessary. Substitu- tion of the conventional syringe for sustained con- trolled suction from a low grade machine or ‘wall’ suction unit may provide a more consistent biopsy specimen with the appropriate submucosal layer, thereby reducing the need for repeat biopsy. This study was conducted to compare the conven- tional method of syringe suction (SSRB) biopsy with biopsy specimens taken by wall or machine suction (WSRB), and to explore the null hypothesis that con- trolled suction does not improve the adequacy of rectal biopsy from suction rectal biopsy apparatus. Materials and methods This was a retrospective study of the hospital records (patient case notes and histopathology laboratory database) of patients who had a RSB at Manchsester Children’s Hospitals between January 2002 and Feb- ruary 2004. The biopsy was considered adequate when the histopathology report unequivocally identified normal ganglia and refuted HD, or when there was a confident diagnosis of HD based on absence of ganglia, A. E. Ali Æ J. A. Morecroft Æ J. C. Bowen Æ J. Bruce Æ A. Morabito (&) Department of Paediatric Surgery, Royal Manchester Children’s Hospital, Hospital Road, Pendlebury, Manchester M27 4HA, UK e-mail: antonino.morabito@cmmc.nhs.uk Pediatr Surg Int (2006) 22:681–682 DOI 10.1007/s00383-006-1714-8 123 ORIGINAL ARTICLE Wall or machine suction rectal biopsy for Hirschsprung’s disease: a simple modified technique can improve the adequacy of biopsy A. E. Ali Æ J. A. Morecroft Æ J. C. Bowen Æ J. Bruce Æ A. Morabito Accepted: 30 March 2006 / Published online: 4 July 2006 Ó Springer-Verlag 2006