An Institutional Analysis and Systematic Review With Meta-analysis of Pneumatic Versus Hydrostatic Reduction for Pediatric Intussusception

Beres, Alana L.; Hsieh, Helen; Khalil, Marwan; Baird, Robert

doi:10.1016/j.jss.2012.10.638

Cited by 11 publications

(17 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The treatment of intussusception after meticulous resuscitation is either nonoperative (hydrostatic/barium enema reduction, or pneumatic reduction, which is recommended by many paediatric surgeons and radiologists) [18,20,[25][26][27][28][29][30][31] or open surgery, with manual reduction and resection of various lengths of gangrenous or irreducible segments of bowel if present [14,18,20,26,27,29,[32][33][34][35][36], or laparoscopic reduction (also with resection of the bowel if required) [35][36][37][38]. This success rate has also been reported by others in our subregion [29], but this is lower than what most centres achieve [30,31,39,40]. This success rate has also been reported by others in our subregion [29], but this is lower than what most centres achieve [30,31,39,40].…”

Section: Resultsmentioning

confidence: 61%

Intestinal obstruction in older children in Komfo Anokye Teaching Hospital

Gyedu¹,

Yifieyeh²,

Nimako³

et al. 2015

Annals of Pediatric Surgery

View full text Add to dashboard Cite

Section: Resultsmentioning

confidence: 61%

Intestinal obstruction in older children in Komfo Anokye Teaching Hospital

Gyedu¹,

Yifieyeh²,

Nimako³

et al. 2015

Annals of Pediatric Surgery

View full text Add to dashboard Cite

“…Postreduction perforation rates have been previously reported to be low, ranging between 0.14 and 0.75% 4,10,18 with most appreciated during, or immediately after, the reduction.…”

Section: Discussionmentioning

confidence: 96%

“…[1][2][3] Pneumatic or hydrostatic enema reduction has become the standard of care for treatment of intussusception in otherwise healthy children, with operative management being reserved for complicated cases (e.g., signs of peritonitis or suspicion of perforation, hemodynamic instability, pathologic lead point) or those who have failed enema reduction. 4,5 Enema reduction has been shown by multiple studies to have a success rate between 70 and 91%. 3,[6][7][8][9] However, this nonoperative reduction technique is not without potential complications, including intestinal perforation, peritonitis, and recurrence of intussusception after initial reduction.…”

mentioning

confidence: 99%

The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception

Lessenich

Kimia

Mandeville

et al. 2015

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: The objective was to determine the frequency of postreduction, hospital-level interventions among children with successful reduction of ileocolic intussusception and identify factors that predict the need for such interventions.Methods: This was a retrospective cross-sectional study of children who underwent successful enema reduction for ileocolic intussusception at a single emergency department. Hospital-level interventions were included if they occurred within 24 hours of reduction and were further classified as either major (recurrence or possible perforation) or minor (imaging for suspected recurrence or administration of parenteral narcotics or antiemetics). Binary logistic regression was used to identify predictors for hospital-level interventions.Results: A total of 464 children underwent enema reduction. The median age was 1.7 years (interquartile range [IQR] = 0.8 to 2.5 years), and 66% were male. A total of 435 (94%) were hospitalized with a median hospital stay of 25 hours (IQR = 19 to 34 hours). Nineteen percent (95% confidence interval [CI] = 15% to 22%) needed postreduction interventions, including 6% (95% CI = 4% to 9%) who required major interventions. The median time to any hospital intervention was 9.9 hours (IQR = 6.3 to 16.4 hours). We identified two independent predictors for hospital-level interventions: duration of symptoms > 24 hours (adjusted odds ratio [OR] = 2.1, 95% CI = 1.3 to 3.4) and location of the intussusception tip at (or proximal to) the hepatic flexure (adjusted OR = 1.9, 95% CI = 1.1 to 3.3); the latter factor was also a predictor of a major intervention. None of the children (95% CI = 0 to 1.0%) had an acute decompensation after an initially successful enema reduction.Conclusions: Clinical decompensation is rare and recurrence is relatively low after an uncomplicated reduction of ileocolic intussusception. However, one in five children required hospital-level interventions after reduction. Children with the intussusception tip at (or proximal to) the hepatic flexure, and those with symptoms for longer than 24 hours, are more likely to require subsequent interventions. Although outpatient management appears safe after a period of observation, caregivers should be counseled about the risk of ongoing symptoms and recurrence.

show abstract

“…This study changed practice during the 1980s and 1990s in most paediatric centres in North America, Europe and Australia due to the lower radiation exposure, elimination of the risks of iodine containing contrast and barium, and the simplicity of the technique. A meta‐analysis in 2013 found fluoroscopic pneumatic reduction more efficacious and safer than the fluoroscopic‐guided contrast enema …”

Section: Introductionmentioning

confidence: 99%

Comparison of safety and efficacy of image‐guided enema reduction techniques for paediatric intussusception: A review of the literature

et al. 2017

View full text Add to dashboard Cite

There is variable international practice regarding the technique used for image-guided enema reduction in paediatric intussusception. A recent meta-analysis found pneumatic reduction to be more effective than hydrostatic techniques. Clinical practice variation may impact on perforation rates, ionizing radiation exposure and requirement for surgery. The aim of this study was to review the literature regarding the efficacy and safety of fluoroscopically guided pneumatic reduction (FGPR) compared to ultrasound (US) guided intussusception reduction (USGIR) techniques for paediatric intussusception treatment. Articles were identified by searching OVID Medline on 21/02/14 and by scanning retrieved articles reference lists. The search was repeated on 30/09/15. Systematic reviews (SR) were appraised with the PRISMA critical appraisal tool. Primary studies underwent a separate critical appraisal process. Successful reductions and perforations per attempt were calculated for each study. Pooled estimates of proportions were calculated for each of these dichotomous outcomes. A SR and 42 primary studies were included in the review. No randomised control trial (RCT) study was included. Non-randomised comparative studies and non-comparative studies suggest that hydrostatic reduction under US control has a similar efficacy and safety profile to pneumatic reduction under fluoroscopic control, but USGIR data are dominated by a single large, non-comparative study performed in China. US-guided intussusception reduction should be considered an alternative to FGPR as it has similar efficacy and safety, and affords no ionised radiation exposure. However, RCT data are required to inform practice.

show abstract

An Institutional Analysis and Systematic Review With Meta-analysis of Pneumatic Versus Hydrostatic Reduction for Pediatric Intussusception

Cited by 11 publications

References 0 publications

Intestinal obstruction in older children in Komfo Anokye Teaching Hospital

Intestinal obstruction in older children in Komfo Anokye Teaching Hospital

The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception

Comparison of safety and efficacy of image‐guided enema reduction techniques for paediatric intussusception: A review of the literature

Contact Info

Product

Resources

About