Recurrence Rates After Intussusception Enema Reduction: A Meta-analysis

Abstract

BACKGROUND AND OBJECTIVE: Reported rates of recurrence after enema reduction for intussusception are variable. Concerns for recurrence influence postreduction management. The objective of this study was to conduct a systematic review and meta-analysis to estimate overall, 24-hour, and 48-hour recurrence rates after enema reduction in children.METHODS: PubMed, Cochrane Database, and OVID Medline were searched from 1946 through December 2011 using the search terms: intussusception, recurrence, and enema. Sixty-nine studies of patients age 0 to 18 years with radiographically proven intussusception reduced by enema that report the number of enema reductions and the number of recurrences were included. Extraction was done by the primary author (M.P.G.) with 10% of included studies independently audited to ensure concordance. RESULTS:Overall recurrence rates were 12.7% (95% confidence interval [CI]: 11.1%-14.4%, I2 = 28.8%) for contrast enema (CE), 7.5% (95% CI: 5.7%-9.8%, I2 = 52.4%) for ultrasound-guided noncontrast enema (UGNCE), and 8.5% (95% CI: 6.9%-10.4%, I2 = 50.1%) for fluoroscopyguided air enema (FGAE). Recurrence rates within 24 hours were 3.9% (95% CI: 2.2%-6.7%, I2 = 47.0%) for CE, 3.9% (95% CI: 1.5%-10.1%, I2 = 0.0%) for UGNCE, and 2.2% (95% CI: 0.7%-6.5%, I2 = 59.8%) for FGAE. Recurrence rates within 48 hours were 5.4% (95% CI 3.7%-7.8%, I2 = 32.3%) for CE, 6.6% (95% CI: 4.0%-10.7%, I2 = 0.0%) for UGNCE, and 2.7% (95% CI: 1.2%-6.5%, I2 = 73.8%) for FGAE. Most included studies are retrospective and vary in quality of reporting. Few studies reported detailed patient characteristics including timing of recurrences. CONCLUSIONS:The risk of early (within 48 hours) recurrence after enema reduction is low, suggesting outpatient management of wellappearing patients should be considered. Pediatrics 2014;134:110-119 AUTHORS:

The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception

“…A 2014 meta-analysis (based on 69 studies) estimated the rate of recurrence for fluoroscopy guided enema to be 8.5% (95% CI = 6.9% to 10.4%) with 26% of these occurring within 24 hours and 32% within the first 48 hours. 19 Based on this low rate of recurrence in the immediate postreduction period, the investigators of the meta-analysis concluded that well-appearing patients can be safely discharged home from the ED. In the current study, we noted an overall recurrence rate of 5.6% within 1 week, with approximately 50% of the repeat enema reductions occurring within 18 hours after the initial reduction.…”

Intussusception patients older than 1 year tend to have early recurrence after pneumatic enema reduction

“…Ultrasonography has been widely adopted to screen and diagnose Intussusception is more likely to recur after nonoperational reduction [3]. Overall recurrence rates after pneumatic enema was around 7.9-8.5 % as previously reported [2,4,5], among them, approximately one-third were early recurrences within 72 h after the reduction [5]. Previous studies have failed to identify consistent risk factors for intussusception recurrence and the characteristic of early recurrence are rarely reported.…”

INTUSSUSCEPTION: A Rural Univercity Hospital Experience

“…Nonoperatif redüksiyonlarda nüksün az görüldüğü (%3-6) ve nükslerinde büyük bir çoğunluğunun 24-48 saat içinde gerçekleştiği bildirilmiştir (10,14) . Bu nedenle olgular redüksiyon sonrası bir gün daha klinikte gözlenmiş ve çıkmadan önce birkez daha US ile kontrol edilmiştir.…”