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Meta-analysis of Air Versus Liquid Enema for Intussusception Reduction in Children
Gelareh Sadigh1, Kelly H Zou2, Seyed Amirhossein Razavi3
11 Department of Radiology, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322.
Insights
Air enema is more effective than liquid enema for reducing intussusception in children. This method offers a higher success rate without increasing the risk of perforation, making it a preferred treatment option.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Medical imaging
Background:
- Intussusception is a common surgical emergency in children.
- Enema reduction is a primary treatment modality for intussusception.
- Comparing air and liquid enema efficacy and safety is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the effectiveness and safety of air versus liquid enema for pediatric intussusception reduction.
- To compare success rates, perforation rates, and recurrence rates between air and liquid enema methods.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane Library databases (1966-2013).
- Inclusion of studies reporting success or perforation rates for air or liquid enema in children with intussusception.
- Random effects modeling used to calculate outcomes: enema reduction success rate, perforation rate, and recurrence rate.
Main Results:
- Air enema demonstrated a higher success rate (82.7%) compared to liquid enema (69.6%).
- Perforation rates were similar for both methods (0.39% for air, 0.43% for liquid).
- Recurrence rates were comparable between air (6%) and liquid (7.3%) enema reduction.
Conclusions:
- Air enema is superior to liquid enema for intussusception reduction in children.
- The higher success rate of air enema is achieved without a significant difference in perforation risk.
- Heterogeneity and publication bias were noted limitations in the study analysis.
Objective:
The purpose of this study was to assess the effectiveness and safety of air versus liquid enema reduction in the treatment of intussusception in children.
Materials And Methods:
Literature searches of the PubMed, Embase, and Cochrane Library databases were conducted from January 1, 1966, through May 31, 2013. Articles on the use of air or liquid enema in children with a confirmed diagnosis of intussusception and reporting either a success rate for enema reduction of intussusception or a perforation rate were selected. Enema reduction success rate, perforation rate, and recurrence rate were the main outcomes and were calculated by random effects modeling.
Results:
One hundred two articles (101 reporting success rate, 71 reporting perforation rate) were included that presented results for 32,451 children (age range, 1 day-22 years; boys, 66%; girls, 34%). In 44 studies (16,187 children), the combined estimate for success rate of air enema was 82.7% (95% CI, 79.9-85.6%; inconsistency index [I(2)] = 97%), and in 52 studies (13,081 children) of liquid enema, it was 69.6% (95% CI, 65.0-74.1%; I(2) = 98%). In 38 studies (15,752 children), the combined estimate of perforation rate for air enema was 0.39% (95% CI, 0.23- 0.55%; I(2) = 40%), and in 30 studies (9429 children) of liquid enema, it was 0.43% (95% CI, 0.24- 0.62%; I(2) = 9%). Among 10,494 children (26 studies) undergoing air enema reduction, the rate of first intussusception recurrence was 6% (95% CI, 4.5-7.5%; I(2) = 89%), similar to the 7.3% (95% CI, 5.8-8.8%; I(2) = 71%) found for 4004 children (24 studies) undergoing liquid enema reduction.
Conclusion:
Air enema was superior to liquid enema for intussusception reduction. The success rate was higher without a difference in perforation rate. Limitations included heterogeneity and publication bias.
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