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Therapeutic enema for pediatric ileocolic intussusception: using a balloon catheter improves efficacy
Bradford W Betz1, Jeffrey E Hagedorn, Jeffrey S Guikema
1Department of Radiology, Helen DeVos Children's Hospital and Spectrum Health, Grand Rapids, MI, 49503, USA, bbetz@advancedrad.com.
Insights
Using an inflated balloon rectal catheter for pediatric intussusception enemas safely shortens air enema procedure times. It also improves liquid enema success rates, offering a beneficial therapeutic option for intussusception treatment.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Medical Devices
Background:
- Pediatric intussusception is a common surgical emergency.
- Therapeutic enemas are a primary non-operative treatment.
- Rectal catheter design may impact enema efficacy.
Purpose of the Study:
- To compare the efficacy of rectal catheters with and without an inflated balloon for air and liquid enemas in pediatric intussusception.
- To evaluate the impact of inflated balloon catheters on procedure time and reduction rates.
- To assess the safety of using inflated balloon catheters.
Main Methods:
- Retrospective review of PACS images and hospital records.
- Inclusion of 62 enemas in 60 pediatric patients treated between January 2006 and May 2011.
- Comparison of outcomes between rectal catheters with and without inflated balloons for air and liquid enemas.
Main Results:
- Air enemas were more frequently performed by specialized physicians, while liquid enemas were more common with general radiologists.
- For air enemas, inflated balloon catheters significantly reduced mean procedure time (7.6 vs. 28.2 min) without affecting reduction rates.
- For liquid enemas, inflated balloon catheters improved the reduction rate (82% vs. 20%) but did not shorten procedure time.
- No complications were attributed to the use of inflated balloon catheters.
Conclusions:
- Rectal catheters with inflated balloons offer a safe and effective adjunct for therapeutic enemas in pediatric intussusception.
- Inflated balloon catheters can significantly decrease air enema procedure duration.
- The use of inflated balloon catheters enhances the success rate of liquid enemas for intussusception reduction.
Abstract:
A therapeutic enema for pediatric intussusception may benefit by using a rectal catheter with an inflated balloon. We compared the efficacy of rectal catheters without and with an inflated balloon for air and liquid enemas. We retrospectively reviewed PACS images and hospital records of children who had a therapeutic enema for intussusception at our institution between January 2006 and May 2011. Sixty-two enemas in 60 children were included. Physician assistants with training in pediatric fluoroscopy and pediatric radiologists were more likely to use air enema (37/41 or 90 %), and general radiologists were more likely to use liquid enema (18/21 or 86 %). However, the reduction rate for air enema overall was only slightly higher than for liquid enema using an inflated balloon catheter (36/40 or 90 % versus 14/17 or 82 %) (P=0.653). For air enema, mean procedure time for successful reductions was shorter with an inflated balloon catheter than with a plastic catheter (7.6 versus 28.2 min) (P<0.009), but the reduction rate was not affected. For liquid enema, the reduction rate was higher with an inflated balloon catheter than without inflation (14/17 or 82 % versus 1/5 or 20 %; P=0.021), but the procedure time was not shortened. No procedural complications were directly attributed to using a rectal catheter with an inflated balloon. Using a rectal catheter with an inflated balloon appears to safely shorten the procedure time of a successful air enema and improve the reduction rate of liquid enema.
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