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A randomized trial of pneumatic reduction versus hydrostatic reduction for intussusception in pediatric patients
Xiaolong Xie1, Yang Wu1, Qi Wang1
1Department of Pediatric Surgery, West China Hospital, Sichuan University, China.
Insights
Hydrostatic reduction for pediatric intussusception showed a higher success rate (96.77%) than pneumatic reduction (83.87%). Ultrasound-guided hydrostatic reduction is a safe and effective initial therapy for intussusception.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intussusception is a common surgical emergency in infants and children.
- Nonoperative reduction techniques, including hydrostatic and pneumatic reduction, are standard initial treatments.
- Limited comparative data exists for these reduction methods in pediatric intussusception.
Purpose of the Study:
- To compare the effectiveness and safety of hydrostatic versus pneumatic reduction for pediatric intussusception.
- To evaluate success rates, intestinal perforations, and recurrence rates.
- To determine the optimal initial nonoperative therapy for intussusception.
Main Methods:
- Prospective randomized controlled trial involving 124 pediatric intussusception patients.
- Patients were randomized to ultrasound-guided hydrostatic reduction or X-ray-guided pneumatic reduction.
- Primary outcome: success rate of reduction. Secondary outcomes: perforation and recurrence rates.
Main Results:
- Overall success rate was 90.32%.
- Hydrostatic reduction success rate (96.77%) was significantly higher than pneumatic reduction (83.87%) (p=0.015).
- One perforation occurred in the pneumatic group; recurrence rates were similar (4.84% vs. 3.23%).
Conclusions:
- Ultrasound-guided hydrostatic reduction is a safe, effective, and simple nonoperative treatment for pediatric intussusception.
- Hydrostatic reduction should be considered the first-line therapy for eligible patients.
- This study supports the superiority of hydrostatic reduction in pediatric intussusception.
Objectives:
Data of randomly controlled trials comparing the hydrostatic and pneumatic reduction for intussusception in pediatric patients as initial therapy are lacking. The aim of this study was to conduct a randomly controlled trial to compare the effectiveness and safety of the hydrostatic and pneumatic reduction techniques.
Study Design:
All intussusception patients who visited West China Hospital of Sichuan University from January 2014 to December 2015 were enrolled in this study in which they underwent pneumatic reduction or hydrostatic reduction. Patients were randomized into ultrasound-guided hydrostatic or X-ray-guided pneumatic reduction group. The data collected includes demographic data, symptoms, signs, and investigations. The primary outcome of the study was the success rate of reduction. And the secondary outcomes of the study were the rates of intestinal perforations and recurrence.
Results:
A total of 124 children with intussusception who had met the inclusion criteria were enrolled. The overall success rate of this study was 90.32%. Univariable analysis showed that the success rate of hydrostatic reduction with normal saline (96.77%) was significantly higher than that of pneumatic reduction with air (83.87%) (p=0.015). Perforation after reduction was found in only one of the pneumatic reduction group. The recurrence rate of intussusception in the hydrostatic reduction group was 4.84% compared with 3.23% of pneumatic reduction group.
Conclusion:
Our study found that ultrasound-guided hydrostatic reduction is a simple, safe and effective nonoperative treatment for pediatric patients suffering from intussusceptions, and should be firstly adopted in the treatment of qualified patients.
Level Of Evidence:
Therapeutic study TYPE OF STUDY: Prospective study.
