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Ultrasound-guided hydrostatic enema reduction for intussusception in children younger than 12 months: a systematic
Amani N Alansari1, Marwa Messaoud2,3, Mohamed Sayed Zaazouee4
1Department of Pediatric Surgery, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. aalansari9@hamad.qa.
Insights
Ultrasound-guided hydrostatic enema reduction (UGHR) is an effective treatment for infant intussusception, with an 80% success rate. While generally safe, perforation risk is linked to country income level, necessitating further research.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intussusception is a leading cause of bowel obstruction in infants.
- It can result in significant patient morbidity.
- Ultrasound-guided hydrostatic enema reduction (UGHR) is a primary non-surgical intervention.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of UGHR in infants under 12 months.
- To evaluate success, recurrence, and perforation rates associated with UGHR.
- To explore factors influencing UGHR outcomes through subgroup analyses.
Main Methods:
- A comprehensive systematic literature search was conducted.
- A random-effects model was employed for pooled estimates.
- Subgroup analyses examined sedation, study design, and income level; evidence certainty was appraised.
Main Results:
- Twenty-two studies comprising 2656 infants were analyzed.
- Pooled success rate was 80%, recurrence 8%, and perforation 2%.
- Lower income levels correlated with higher perforation risk; evidence certainty was low.
Conclusions:
- UGHR is a clinically effective and safe non-surgical option for hemodynamically stable infants with intussusception.
- Further high-quality, multicenter studies are required to optimize treatment protocols.
- Standardized global guidelines are needed to enhance UGHR outcomes.
Background And Objectives:
Intussusception is the most common cause of bowel obstruction in infancy and may lead to substantial morbidity. This systematic review and meta-analysis evaluated success, recurrence, and perforation rates of ultrasound-guided hydrostatic enema reduction (UGHR) in infants younger than 12 months.
Methods:
A systematic search was performed from database inception through January 2026. A random-effects model was applied to generate pooled estimates. Analyses, including subgroup analyses by sedation status, study design, and country income level, were conducted in R, and certainty of evidence was appraised.
Results:
Twenty-two studies, including 2656 infants, met the inclusion criteria. The pooled success rate was 80%, the recurrence rate was 8%, and the perforation rate was 2%. Subgroup analysis demonstrated no significant effect of sedation status or study design on outcomes, whereas income level was significantly associated with perforation risk. Substantial heterogeneity was observed across outcomes. Overall certainty of evidence was low.
Conclusions:
UGHR demonstrates a clinically meaningful success rate with an acceptable safety profile in infants under 12 months, supporting its role as a safe and effective non-surgical treatment in hemodynamically stable patients. Standardized global protocols and high-quality prospective multicenter studies are needed to optimize outcomes and strengthen the evidence base.
