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Recurrence rates after intussusception enema reduction: a meta-analysis.

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The risk of intussusception recurrence after enema reduction is low, especially within 48 hours. This suggests outpatient management may be suitable for well-appearing children following successful enema reduction.

Keywords:
enemaintussusceptionrecurrence

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Area of Science:

  • Pediatric Gastroenterology
  • Surgical Outcomes
  • Medical Informatics

Background:

  • Intussusception is a common pediatric surgical emergency.
  • Enema reduction is a primary treatment modality for intussusception.
  • Recurrence rates after enema reduction vary, impacting post-procedure management decisions.

Purpose of the Study:

  • To systematically review and meta-analyze recurrence rates following enema reduction for intussusception in children.
  • To estimate overall, 24-hour, and 48-hour recurrence rates.
  • To inform clinical decision-making regarding postreduction management and potential for outpatient care.

Main Methods:

  • Systematic literature search of PubMed, Cochrane Database, and OVID Medline (1946-2011).
  • Inclusion of 69 studies involving children (0-18 years) with radiographically confirmed intussusception reduced by enema.
  • Data extraction on enema reductions and recurrence numbers, with independent auditing of 10% of studies.

Main Results:

  • Overall recurrence rates: 12.7% for contrast enema (CE), 7.5% for ultrasound-guided noncontrast enema (UGNCE), and 8.5% for fluoroscopy-guided air enema (FGAE).
  • Early recurrence (within 48 hours) rates were low across all methods: CE (5.4%), UGNCE (6.6%), and FGAE (2.7%).
  • Heterogeneity noted in study quality and reporting of patient characteristics and recurrence timing.

Conclusions:

  • The risk of early recurrence after enema reduction for intussusception is low.
  • Outpatient management should be considered for well-appearing children after successful enema reduction.
  • Further research may be needed to standardize reporting of recurrence data.