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Utility of gastrointestinal fluoroscopic studies in detecting stricture after neonatal necrotizing enterocolitis
Emily L Wiland1, Andrew P South, Steven J Kraus
1*Division of Neonatology †Division of Pediatric Radiology ‡Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Contrast enema (CE) is more effective than upper gastrointestinal study with small bowel follow-through (UGI-SBFT) for diagnosing post-necrotizing enterocolitis (NEC) strictures. A negative CE or UGI-SBFT should not exclude a stricture in symptomatic patients.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Necrotizing enterocolitis (NEC) can lead to gastrointestinal strictures in neonates.
- Accurate diagnosis of post-NEC strictures is crucial for appropriate management.
- Upper gastrointestinal study with small bowel follow-through (UGI-SBFT) and contrast enema (CE) are used to evaluate for these strictures.
Purpose of the Study:
- To evaluate the 5-year institutional experience with UGI-SBFT and CE for diagnosing post-NEC strictures.
- To determine the sensitivity and specificity of UGI-SBFT and CE in identifying these strictures.
- To compare the diagnostic performance of UGI-SBFT and CE.
Main Methods:
- Retrospective observational cohort study of neonates with Bell's modified stage 2 or 3 NEC.
- Inclusion of patients who underwent UGI-SBFT and/or CE for stricture evaluation.
- Confirmation of stricture presence by exploratory laparotomy and pathology.
Main Results:
- Contrast enema (CE) demonstrated higher sensitivity (0.667) compared to UGI-SBFT (0.00) for small bowel strictures.
- CE showed a specificity of 0.951 for small bowel and/or colonic strictures.
- Strictures were more frequently identified in symptomatic infants (28%) versus asymptomatic infants (8%).
Conclusions:
- Contrast enema (CE) is recommended as the initial imaging study for suspected post-NEC strictures due to its higher detection rate.
- Low sensitivity of both UGI-SBFT and CE means a negative study should not rule out stricture in persistently symptomatic neonates.
- Further investigation is warranted for persistently symptomatic infants with negative imaging results.
Objectives:
We report our institution's 5-year experience with upper gastrointestinal study with small bowel follow-through (UGI-SBFT) and contrast enema (CE) for the diagnosis of a post-necrotizing enterocolitis (NEC) stricture. We hypothesized that sensitivity and specificity of UGI-SBFT and CE were <85% in diagnosing a post-NEC stricture.
Methods:
A retrospective observational cohort study was performed. Included patients were neonates diagnosed as having Bell's modified stage 2 or 3 NEC who had undergone UGI-SBFT and/or CE to evaluate for a stricture. Exploratory laparotomy was used to definitively determine the stricture presence, which was confirmed by pathology. An infant was categorized as having no stricture if no surgical intervention occurred or if no stricture was reported on pathology following surgical resection.
Results:
A total of 56 patients met inclusion criteria, with 51 UGI-SBFT and 85 CE performed. A total of 25 patients were diagnosed as having a stricture. For small bowel (SB) strictures, CE compared with UGI-SBFT has a higher sensitivity (0.667 vs 0.00) and a similar specificity (0.857 vs 0.833). For SB and/or colonic strictures, CE has a sensitivity of 0.667 and a specificity of 0.951. Strictures were more likely to be found on imaging in symptomatic infants compared with those in asymptomatic infants (28% vs 8%, P = 0.002).
Conclusions:
CE should be the initial study in the diagnostic workup for a post-NEC stricture because this test has a higher likelihood of detecting a stricture if it is present. As a result of low sensitivity of UGI-SBFT and/or CE in the diagnosis of a post-NEC stricture, a negative study should not rule out the diagnosis of a stricture in persistently symptomatic patients.
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