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

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish
Pages (from-to)711-717
Number of pages7
JournalJournal of medical imaging and radiation oncology
Volume61
Issue number6
DOIs
Publication statusPublished - Dec 2017

Keywords

  • Enema
  • Fluoroscopy
  • Intussusception
  • Systematic review
  • Ultrasound

Cite this

@article{160689ba338d496290386f2b3ca09172,
title = "Comparison of safety and efficacy of image-guided enema reduction techniques for paediatric intussusception: A review of the literature",
abstract = "Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.",
keywords = "Enema, Fluoroscopy, Intussusception, Systematic review, Ultrasound",
author = "Renny Chew and Michael Ditchfield and Eldho Paul and Goergen, {Stacy K.}",
year = "2017",
month = "12",
doi = "10.1111/1754-9485.12601",
language = "English",
volume = "61",
pages = "711--717",
journal = "Journal of medical imaging and radiation oncology",
issn = "1754-9477",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Comparison of safety and efficacy of image-guided enema reduction techniques for paediatric intussusception

T2 - A review of the literature

AU - Chew, Renny

AU - Ditchfield, Michael

AU - Paul, Eldho

AU - Goergen, Stacy K.

PY - 2017/12

Y1 - 2017/12

N2 - Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.

AB - Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.

KW - Enema

KW - Fluoroscopy

KW - Intussusception

KW - Systematic review

KW - Ultrasound

UR - http://www.scopus.com/inward/record.url?scp=85017541613&partnerID=8YFLogxK

U2 - 10.1111/1754-9485.12601

DO - 10.1111/1754-9485.12601

M3 - Article

VL - 61

SP - 711

EP - 717

JO - Journal of medical imaging and radiation oncology

JF - Journal of medical imaging and radiation oncology

SN - 1754-9477

IS - 6

ER -