Variations in Paediatric Intussusception Radiologic Enema Reduction Practices Across Aotearoa New Zealand: Results...

Most children with intussusception are successfully treated with radiologic enema reduction. Our recent nationwide study revealed significant variation in enema reduction success and the requirement of secondary operative intervention. This may be due to variation in the management of intussusception. As such, radiologic enema management patterns across Aotearoa New Zealand (AoNZ) were investigated.

A snapshot survey of all AoNZ radiologists who had managed paediatric intussusception in the preceding 5 years was performed. Survey answers were collected anonymously via REDCap between April 1, 2023, and July 1, 2023. Network sampling was used to attain respondent saturation.

Responses were recorded from 24 of the 26 radiologists who had recently managed paediatric intussusception. An institutional management guideline was available in 88% of cases. Pneumatic reduction via Foley catheter under fluoroscopic guidance was used preferentially by 23 clinicians (96%). Respondents described a wide range of catheter retention strategies and reduction hardware. There was significant variation in reported initial (0-120 mmHg) and peak (100-130 mmHg) reduction pneumatic pressures. If partially successful, respondents attempted further reduction after 0-5 min with a maximum of 3-8 attempts per sitting. Most clinicians confirmed reduction with small bowel insufflation (92%), but seven utilised post-reduction ultrasound (29%).

Almost all AoNZ centres relied on pneumatic reduction under fluoroscopic guidance and rarely utilised hydrostatic or ultrasound-guided reduction. Reduction hardware and catheter retention strategies were diverse. There was inter-centre variation in pneumatic pressure limits, reduction timing, and periprocedural care. Intussusception care could benefit from a multidisciplinary, standardised, national approach.