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An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for
1Montreal Children's Hospital, Division of Pediatric General and Thoracic Surgery, Montreal, Quebec, Canada.
Insights
Pneumatic reduction is more successful for treating pediatric intussusception than contrast enemas. This method offers a higher success rate without increasing complications, making it the preferred choice.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Medical device technology
Background:
- Intussusception is a common cause of bowel obstruction in children.
- Enema reduction is the typical treatment, but optimal techniques are debated.
- Minimizing morbidity while maximizing success is crucial.
Purpose of the Study:
- To compare the efficacy and safety of pneumatic versus hydrostatic enema reduction for intussusception.
- To determine the optimal reduction technique for pediatric intussusception.
Main Methods:
- Institutional data review comparing air versus contrast medium enema reduction.
- Systematic review of comparative studies on pneumatic versus hydrostatic reduction.
- Meta-analysis using REVMAN 5.1 with critical appraisal (MINORS, Jadad score).
Main Results:
- Pneumatic reduction showed a lower failure rate (OR 0.45) compared to contrast reduction.
- Sensitivity analysis confirmed pneumatic reduction's superiority in prospective studies (OR 0.39).
- No significant difference in perforation rates between the two methods was observed.
Conclusions:
- Pneumatic reduction is more effective for intussusception treatment in children.
- Pneumatic reduction does not increase morbidity compared to hydrostatic reduction.
- Pneumatic reduction should be the preferred method for intussusception treatment when feasible.
Background:
Intussusception remains a frequent cause of bowel obstruction in children and typically is treated by reduction via enema. Controversy persists regarding the optimal reduction technique to maximize success while minimizing morbidity.
Methods:
We reviewed our institutional data comparing outcomes of enema reduction that use contrast medium versus air. A systematic review also was undertaken of comparative studies evaluating pneumatic (oxygen or air) versus hydrostatic (any contrast medium) reduction. Critical appraisal was performed with the Methodological Index for Non Randomized Studies scale for observational studies, Jadad score for randomized trials. Meta-analysis was performed with REVMAN 5.1.
Results:
Institutional data revealed a failed reduction rate of 20.4% (20/98) with air and 29.6% (8/27) with contrast reduction. Nineteen studies were included in the systematic review. The cumulative failure rate favored pneumatic reduction (odds ratio [OR] 0.45; 95% confidence interval [95% CI] 0.34-0.60); sensitivity analysis of prospective studies demonstrated similar results (OR 0.39; 95% CI 0.24-0.63). The number needed to treat to eliminate one failed reduction was nine pneumatic reductions. No difference was noted in reported perforations (OR 0.98; 95% CI 0.48-2.03).
Conclusion:
Pneumatic reduction is more likely to successfully reduce intussusception in children without evidence of increased morbidity. In the context of available expertise, pneumatic reduction should be the method of choice for the treatment of intussusception barring an indication for immediate operative intervention.