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Pneumatic versus liquid enema reduction in the management of pediatric intussusception: an updated systematic review
Ruaa Mustafa Qafesha1,2, Israa Sharabati1,2, Muataz Kashbour2,3
1Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
Insights
Pneumatic enema reduction is more successful and faster for infant intussusception than liquid enemas. This air versus liquid enema study found pneumatic reduction to be a preferred nonsurgical treatment with similar safety profiles.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intussusception is a common cause of bowel obstruction in infants.
- Nonsurgical reduction using enemas is the standard treatment for intussusception.
- Evaluating air versus liquid enema efficacy is crucial for optimizing pediatric care.
Purpose of the Study:
- To compare the efficacy and safety of air (pneumatic) versus liquid (hydrostatic) enema reduction for pediatric intussusception.
- To assess key outcomes including reduction success, perforation, and recurrence rates.
- To analyze secondary outcomes such as hospital stay, reduction time, pressure, and fluoroscopy time.
Main Methods:
- A comprehensive literature search was performed across electronic databases.
- A meta-analysis included 29 studies with 9281 pediatric patients comparing air and liquid enemas.
- Primary outcomes were reduction success, perforation, and recurrence rates; secondary outcomes included procedural and hospital stay metrics.
Main Results:
- Pneumatic reduction demonstrated a significantly higher success rate (RR 1.22, 95% CI [1.12, 1.34]) and shorter reduction time (MD -2.64, 95% CI [-4.73, -0.55]).
- No significant differences were observed in perforation rates, recurrence rates, hospital stay duration, reduction pressure, or fluoroscopy time.
- Subgroup analyses indicated consistent superiority of pneumatic reduction, particularly before 2011 and in non-pediatric radiology settings.
Conclusions:
- Pneumatic enema reduction is a more successful and faster nonsurgical treatment for pediatric intussusception compared to liquid enemas.
- The safety profile of pneumatic reduction is comparable to hydrostatic methods, supporting its use as a preferred approach.
- Further research is recommended to specifically evaluate radiation dose and fluoroscopy time in comparative studies.
Introduction And Importance:
Intussusception is the most frequent cause of bowel obstruction in infants. Most cases are managed nonsurgically with liquid or enema reduction. Our study aims to evaluate the efficacy and safety of air versus liquid enema reduction for the treatment of intussusception in pediatric patients.
Materials And Methods:
A literature search was conducted on electronic databases, and the references of all included studies were searched to identify additional relevant studies meeting our inclusion criteria. Our meta-analysis included studies that compared the use of air and liquid enemas in pediatric patients with intussusception. The primary outcomes assessed were reduction success, perforation, and recurrence rates. Secondary outcomes included hospital stay duration, reduction time, reduction pressure, and fluoroscopy time. Meta-analysis was performed using RevMan 5.4.
Results:
Twenty-nine studies were included in the analysis, encompassing 9281 patients. The pneumatic reduction was significantly associated with a higher success rate (risk ratio: 1.22, 95% confidence interval [CI]: {1.12, 1.34}) and a shorter reduction time (mean difference [MD]: -2.64, 95% CI: [-4.73, -0.55]). No significant difference was found between the two procedures in terms of perforation rate, recurrence rate, length of hospital stays, reduction pressure, and fluoroscopy. Subgroup analysis revealed that pneumatic reduction had higher success rates in both RCTs and cohort studies and was superior to liquid reduction before the year 2011. After 2011, both techniques had similar success rates. Pneumatic reduction also showed higher success rates in both children's and non-children's hospitals and among the general radiologists' subgroup, though pediatric radiologists achieved similar success rates with both techniques.
Conclusions:
Pneumatic enema reduction offers higher success and faster treatment for pediatric intussusception, with comparable safety to hydrostatic methods, supporting its use as the preferred nonsurgical approach. Further comparative studies are recommended to examine radiation dose and fluoroscopy time.
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