Gastro-gastric intussusception in adults: a systematic review with exploratory statistical analysis

Gastro-gastric intussusception in adults is a rare clinical entity and the existing literature is limited, not systematically analysed and scattered. This systematic review aims to synthesise the current evidence on the clinical presentations, diagnostic modalities and management strategies of this rare condition, breaching the research gap.

This review adhered to the PRISMA guidelines with an extensive systematic search in PubMed, Scopus, Google Scholar, OpenGrey and Directory of Open Access Journals, up to 23rd of August. English literature, including patients ≥ 16 years of age with gastro-gastric intussusception confirmed intra-operatively, radiologically, or endoscopically were included. Exploratory statistics were performed utilising descriptive statistics for data summary, Chi-square tests for group comparisons, event-based counts when patients contributed to multiple observations and confidence intervals for independent proportions using the modified Wald method, where applicable.

Forty-three cases met inclusion criteria. The mean age was 59.7 ± 20.7 years, with a predominance of females (77%, p = 0.0011) and adults ≥ 65 years (p = 0.0092). Comorbidities included gastrointestinal/hepatic disorders (25.8%) and prior abdominal surgery (18.0%) (p < 0.0001). Most patients presented with gastrointestinal symptoms (72.5%). CT was the most frequently used diagnostic modality (74.4%) with 100% yield, followed by endoscopy (65.1%, yield 89.3%). Gastro-intestinal stromal tumors were the most common etiological factor (23.3%), followed by polyps and surgery (13.9% each). Surgical resection was the main treatment (58.1%), with conservative (11.6%) or endoscopic (9.3%) approaches reserved for selected cases. Recovery with discharge occurred in 60.5%, discharge with follow up or ongoing management occurred in 11.7%, while mortality was 4.7% and recurrence 0% (p = 0.0001). The rest of the studies did not report any outcomes.

Adult gastro-gastric intussusception predominantly affects older females and presents with gastrointestinal symptoms. CT is the diagnostic modality of choice, and surgical resection remains the cornerstone of treatment. Standardized reporting and prospective registries are needed to optimize diagnosis and management.