Hydrostatic Reduction of Childhood Intussusception

Mortensson, W.; Eklöfn, O.; Laurin, S

doi:10.1177/028418518402500402

Cited by 22 publications

(8 citation statements)

References 14 publications

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“…Glucagon has muscle relaxant effects as well as Buscopan, and has been used for enema reduction. In earlier reports, the reduction rate was higher when Glucagon was used 80,82 (level 3b); however, more recent randomized controlled studies have shown that glucagon is of no benefit 84,85 (level 2b). The use of glucagon is not recommended as it is an expensive drug in comparison to Buscopan, and health insurance in Japan may not cover the fee.…”

Section: Treatmentmentioning

confidence: 93%

Japanese guidelines for the management of intussusception in children, 2011

Ito

Kusakawa

Murata

et al. 2012

Pediatrics International

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Background: The Japanese Society of Emergency Pediatrics has formulated evidence-based guidelines for the management of intussusception in children in order to diagnose intussusceptions promptly, to initiate appropriate treatment as early as possible, and to protect intussuscepted children from death. Methods: Literature was collected systematically via the Internet using the key words "intussusception" and "children."The evidence level of each paper was rated in accordance with the levels of evidence of the Oxford Center for Evidence-based Medicine. The guidelines consisted of 50 clinical questions and the answers. Grades of recommendation were added to the procedures recommended on the basis of the strength of evidence levels. Results: Three criteria of "diagnostic criteria," "severity assessment criteria," and "criteria for patient transfer" were proposed aiming at an early diagnosis, selection of appropriate treatment, and patient transfer for referral to a tertiary hospital in severe cases. Barium is no longer recommended for enema reduction (recommendation D) because the patient becomes severely ill once perforation occurs. Use of other contrast media, such as water-soluble iodinated contrast, normal saline, or air, is recommended under either fluoroscopic or sonographic guidance. Delayed repeat enema improves reduction success rate, and is recommended if the initial enema partially reduced the intussusception and if the patient condition is stable. Conclusions:The guidelines offer standards of management, but it is not necessarily the purpose of the guidelines to regulate clinical practices. One should judge each individual clinical situation in accordance with experiences, available devices, and the patient's condition.

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Section: Treatmentmentioning

confidence: 93%

Japanese guidelines for the management of intussusception in children, 2011

Ito

Kusakawa

Murata

et al. 2012

Pediatrics International

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“…We included six RCTs with a total of 822 participants (Essa 2011;Franken 1983;Hadidi 1999;Lin 2000;Meyer 1993;Mortensson 1984), and we identified three ongoing trials (El Fiky 2016; Mehraeen 2011; Zhang 2015).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Two of the seven remaining publications were duplicates; thus we included them as one trial (Lin 2000). In summary, we included six RCTs (Essa 2011;Franken 1983;Hadidi 1999;Lin 2000;Meyer 1993;Mortensson 1984) in the review. These six completed trials were published in five di erent journals.…”

Section: Cochrane Database Of Systematic Reviewsmentioning

confidence: 99%

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Management for intussusception in children

Gluckman

Karpelowsky

Webster

et al. 2017

Cochrane Database of Systematic Reviews

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This review identified a small number of trials that assessed a variety of interventions. All included trials provided evidence of low quality and were subject to serious concerns about imprecision, high risk of bias, or both. Air enema may be superior to liquid enema for successfully reducing intussusception in children; however, this finding is based on a few studies including small numbers of participants. Dexamethasone as an adjuvant may be more effective in reducing intussusception recurrence rates following air enema or liquid enema, but these results are also based on a few studies of small numbers of participants. This review highlights several points that need to be addressed in future studies, including reducing the risk of bias and including relevant outcomes. Specifically, surgical trials are lacking, and future research is needed to address this evidence gap.

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“…Our institution does not use sedation during enema reduction attempts; however, the literature lacks conclusive data about the efficacy of sedation in aiding attempts at enema reduction. 6,[13][14][15][16] There was a 14.1% referral rate (n ¼ 19) for our intussusception patients, for which patients initially diagnosed at a referring institution were transferred to our hospital for definitive care. These transfers from the community predispose these patients to a longer duration of symptoms and delay in intervention which may affect success of a primary reduction, although data are inconsistent in determining if longer duration of symptoms affects the rate of successful enema reduction.…”

Section: Discussionmentioning

confidence: 99%