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Ultrasound-guided hydrostatic reduction versus fluoroscopy-guided air reduction for pediatric intussusception: a
Shu Ting Liu1, Xiao Bing Tang1, Huan Li2
1Department of Pediatric Surgery, Shengjing Hospital, China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, P. R. China.
Insights
Ultrasound-guided hydrostatic reduction (UGHR) shows higher success rates than fluoroscopy-guided air reduction (FGAR) for pediatric intussusception. Both methods are safe, but UGHR offers a radiation-free option with superior outcomes, particularly for infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intussusception is a common pediatric abdominal emergency.
- Enema reduction is the primary treatment for uncomplicated cases.
- Lack of multi-center studies comparing UGHR and FGAR.
Purpose of the Study:
- Compare effectiveness and safety of ultrasound-guided hydrostatic reduction (UGHR) and fluoroscopy-guided air reduction (FGAR).
- Evaluate success, recurrence, and perforation rates for pediatric intussusception treatment.
Main Methods:
- Multi-center, prospective cohort study (November 2017-October 2018).
- 2124 children with intussusception divided into UGHR and FGAR groups.
- Stratified and subgroup analyses used to compare outcomes.
Main Results:
- UGHR group had higher success rates (95.80%) than FGAR (93.13%).
- Perforation rates were similar (UGHR: 0.36%, FGAR: 0.30%).
- UGHR showed superior success in specific subgroups (12-24h onset, 4-24 months, bloody stool).
Conclusions:
- UGHR and FGAR are safe, non-surgical treatments for pediatric intussusception.
- UGHR is superior to FGAR due to higher success rates and no radiation risk.
- UGHR is particularly beneficial for children aged 4-24 months.
Background:
Intussusception is the most common abdominal emergency in children. The first line treatment of uncomplicated pediatric intussusception is enema reduction. Until now, there have been no multi-center studies comparing the effectiveness and safety of UGHR and FGAR in the treatment of pediatric intussusception. The aim of this study was to compare the effectiveness and safety of the two most commonly used enema methods of pediatric intussusception: ultrasound-guided hydrostatic reduction (UGHR) and fluoroscopy-guided air reduction (FGAR).
Methods:
From November 1, 2017 to October 31, 2018, we conducted a multi-center, prospective, cohort study. Children diagnosed with intussusception in four large Children's Medical Centers in China were divided into UGHR and FGAR groups. Stratified analysis and subgroup analysis were used for further comparison. The success and recurrence rates were used to evaluate the effectiveness of enema reduction. The perforation rate was used to evaluate the safety of enema reduction.
Results:
A total of 2124 cases met the inclusion criteria (UGHR group: 1119 cases; FGAR group: 1005 cases). The success and recurrence rates in the UGHR group were higher than in the FGAR group (95.80%, 9.28% vs. 93.13%, 10.65%) (P < 0.05, P > 0.05), respectively. The perforation rate in the UGHR group was 0.36% compared with 0.30% in the FGAR group (P > 0.05). Subgroup analysis showed the success rates in the UGHR group were higher than in the FGAR group of patients with onset time between 12 and 24 h (95.56% vs. 90.57%) (P < 0.05). Of patients aged 4 to 24 months, the success rates in the UGHR group were also higher than in the FGAR group (95.77% vs. 91.60%) (P < 0.05). Stratified analysis showed the success rates in the UGHR group were higher than in the FGAR group in patients with the symptom of bloody stool (91.91% vs 85.38%) (P < 0.05).
Conclusions:
UGHR and FGAR are safe, nonsurgical treatment methods for acute pediatric intussusception. UGHR is superior to FGAR, no radiation risk, its success rate is higher, without a difference in perforation rate, especially for patients aged 4-24 months.
Level Of Evidence:
Level II.
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