An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for pediatric intussusception

Alana L. Beres, Robert Baird

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Intussusception remains a frequent cause of bowel obstruction in children and typically is treated by reduction via enema. Controversy persists regarding the optimal reduction technique to maximize success while minimizing morbidity. Methods: We reviewed our institutional data comparing outcomes of enema reduction that use contrast medium versus air. A systematic review also was undertaken of comparative studies evaluating pneumatic (oxygen or air) versus hydrostatic (any contrast medium) reduction. Critical appraisal was performed with the Methodological Index for Non Randomized Studies scale for observational studies, Jadad score for randomized trials. Meta-analysis was performed with REVMAN 5.1. Results: Institutional data revealed a failed reduction rate of 20.4% (20/98) with air and 29.6% (8/27) with contrast reduction. Nineteen studies were included in the systematic review. The cumulative failure rate favored pneumatic reduction (odds ratio [OR] 0.45; 95% confidence interval [95% CI] 0.34-0.60); sensitivity analysis of prospective studies demonstrated similar results (OR 0.39; 95% CI 0.24-0.63). The number needed to treat to eliminate one failed reduction was nine pneumatic reductions. No difference was noted in reported perforations (OR 0.98; 95% CI 0.48-2.03). Conclusion: Pneumatic reduction is more likely to successfully reduce intussusception in children without evidence of increased morbidity. In the context of available expertise, pneumatic reduction should be the method of choice for the treatment of intussusception barring an indication for immediate operative intervention.

Original languageEnglish (US)
Pages (from-to)328-334
Number of pages7
JournalSurgery (United States)
Volume154
Issue number2
DOIs
StatePublished - Aug 1 2013

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Intussusception
Meta-Analysis
Enema
Odds Ratio
Air
Confidence Intervals
Pediatrics
Contrast Media
Morbidity
Numbers Needed To Treat
Observational Studies
Prospective Studies
Oxygen
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for pediatric intussusception. / Beres, Alana L.; Baird, Robert.

In: Surgery (United States), Vol. 154, No. 2, 01.08.2013, p. 328-334.

Research output: Contribution to journalArticle

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