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Sclerotherapy for rectal prolapse in children: A systematic review and meta-analysis
Graeme Charles Hintz1, Vito Zhaoxin Zou2, Robert Baird3
1Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada; Division of General Surgery, Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada.
Insights
Sclerotherapy is an effective and safe treatment for pediatric rectal prolapse, offering a low-risk alternative to surgery. Further high-quality research is needed to confirm these findings.
Area of Science:
- Pediatric Gastroenterology
- Surgical Innovation
- Medical Treatments
Background:
- Sclerotherapy is a common treatment for pediatric rectal prolapse.
- This study systematically reviews its effectiveness and complications.
Purpose of the Study:
- To evaluate the efficacy and safety of various sclerosing agents for pediatric rectal prolapse.
- To compare sclerotherapy with other treatment options.
Main Methods:
- Systematic review of studies on injection sclerotherapy for pediatric rectal prolapse.
- Data extraction and quality assessment using the MINORS score.
- Included 19 studies published between 1970 and 2017.
Main Results:
- 1510 patients (mean age 4.5 years) were analyzed.
- Ethanol and phenol were the most common sclerosing agents.
- Overall success rate was 76.9% with a 14.4% complication rate.
Conclusions:
- Injection sclerotherapy is effective and low-risk for pediatric rectal prolapse.
- Consider sclerotherapy before surgical interventions.
- High-quality prospective studies are needed due to current evidence limitations.
Background:
Sclerotherapy is a commonly utilized treatment for rectal prolapse in children. This study systematically evaluates the effectiveness and complications of various sclerosing agents in treating pediatric rectal prolapse.
Methods:
After protocol registration (CRD-42018088980), multiple databases were searched. Studies describing injection sclerotherapy for treatment of pediatric rectal prolapse were included, with screening and data abstraction duplicated. The methodological quality of included papers was assessed using the Methodological Index for Non-Randomized Studies (MINORS) score.
Results:
Nineteen studies were identified, published between 1970 and 2017. Most studies were single institution case series, with median "N" 57+/-88.9 and mean MINORS score of 0.51+/-0.17 (perfect score = 1). 1510 patients with a mean age of 4.5 years were accounted for: 36.2% female, most without comorbidities. Mean follow up length was 30 months. The most common sclerosing agent described was ethanol (45%), followed by phenol (33%). The mean number of treatments per patient was 1.1+/-0.34. The overall success rate after a single sclerotherapy treatment was 76.9%+/-8.8%. The overall complication rate was 14.4%+/-2%.
Conclusions:
Injection sclerotherapy appears effective and low-risk in the treatment of pediatric rectal prolapse and should be considered before more invasive surgical options. The available evidence is of relatively poor quality, and prospective comparative investigations are warranted.
Level Of Evidence:
3 (meta-analysis of level 3 studies).
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