A comparison of fluoroscopy-guided pneumatic reduction and ultrasound-guided hydrostatic reduction of intussusception in children : a systematic review and meta-analysis

Abstract

Aim: The goal of this meta-analysis was to assess the effectiveness and safety of pneumatic versus hydrostatic enema reduction of intussusception in the paediatric population. Methods: A systematic literature search was conducted by querying 3 databases namely Cochrane, PubMed, and Scopus for relevant literature published between January 2012 and January 2023. The focus of the review was on studies investigating the utilization of pneumatic or hydrostatic enema in children diagnosed with intussusception. The inclusion criteria encompassed studies that reported the success rate of enema reduction and the rate of perforation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcomes of interest included enema reduction success rate, perforation rate, and recurrence rate. Statistical analysis was performed using Stata Statistical Software (Release 17) and the Statistical Package for the Social Sciences. Results: A total of 46 studies were included in this meta-analysis. The studies together included data on 22,090 patients. The average age of the patients was 1.4 years, with 62% of the patients being male. The combined success rate of hydrostatic reduction under ultrasound guidance was 80.1% (SD=18), and the combined success rate of pneumatic reduction under fluoroscopy guidance was 82.0% (SD=12.7). This difference was not statistically significant (p=0.3). There was a statistically significant difference in combined rates of perforation however, with a perforation rate of 1.4% (SD=2.8) with hydrostatic reduction and 0.64% (SD=0.9) with pneumatic reduction (p=0.007). Recurrence rates were comparable between both methods of reduction, with recurrence of 5.0% (SD=6.1) with hydrostatic reduction and 4.9% (SD=6.3) with pneumatic reduction (p= 0.9). Conclusion: Fluoroscopy guided air enema and hydrostatic enema under ultrasound guidance, are both as efficacious in reducing paediatric intussusception. There is a higher rate of perforation with hydrostatic enema.