Gelareh Sadigh MD, Presenter: Nothing to Disclose

Kelly H. Zou PhD, Abstract Co-Author: Director, Pfizer Inc Stockholder, Pfizer Inc

Seyed Amirhossein Razavi MD, Abstract Co-Author: Nothing to Disclose

Ramsha Khan, Abstract Co-Author: Nothing to Disclose

Kimberly E. Applegate MD, MS, Abstract Co-Author: Co-editor, Springer Science+Business Media Deutschland GmbH Advisory Board, WellPoint, Inc

To assess the effectiveness of air vs. liquid enema reduction for treating intussusception in children stratified by reduction guidance.

Literature search of PubMed, EMBASE, and the Cochrane Library Databases was conducted (1/1/1966-5/31/2013). Studies reporting reduction success rate, using air/liquid enema in children with confirmed diagnosis of intussusception, and reporting enema guidance, fluoroscopy(FL) or ultrasonography (US), air pressure or liquid bag height, were included. Studies in non-English language and with number of air/liquid enemas<50 were excluded. Three reviewers independently assessed the quality and abstracted the eligible studies, with disagreements resolved by consensus. Systematic review and meta-analysis were conducted to combine the enema success and perforation rate by guidance method. Five studies with mixed guidance were not included for comparisons. 95% confidence intervals(CI) were constructed.

A total of 12,277 children (66% male, 26%-79%/study) were included. Children aged 1day-22 years. Under FL, the combined success rates from 23 studies (6,038 children) undergoing air enema was 84%(CI 82-86%;I2=82%) and 68%(CI 62-74%;I2=94%) in 26 studies (3,534 children) undergoing liquid enema (P<0.001). Perforation rate from 21 studies (5,766 children) undergoing air enema was 0.4%(CI 0.2-0.6%;I2=33%) and 0.6%(CI 0.2-0.9%;I2=0%) in18 studies (2,124 children) undergoing liquid enema(P=0.36). Under US, the combined success rates were 89% (CI 79->99%;I2=94%) from 4 studies (454 children) undergoing air enema and 86% (CI 81-91%;I2=81%) from 7 studies (994 children) undergoing liquid enema (P=0.10). Perforation rate from 3 studies (255 children) undergoing air enema was 3%(CI 0-6%;I2=65%) and from 2 studies (250 children) undergoing liquid enema was 0.3%(CI 0-1%;I2=0%)(P=0.08). Reduction success rate had a small correlation with maximum reported pressure used for air enema in 32 studies(Spearman r=4.2%) and a large correlation with maximum height of bag for liquid enema in 31 studies(Spearman r=51%).

Air was superior to liquid enema for intussusception reduction without higher perforation rate. Limitations included high heterogeneity and publication bias.

Air enema had a higher reduction rate over liquid enema for intussusception reduction in children, specifically when used under fluoroscopy without a significant difference in perforation rate.

Sadigh, G, Zou, K, Razavi, S, Khan, R, Applegate, K, A Systematic Review and Meta-Analysis of Air versus Liquid Enema Stratified by Technique for Intussusception Reduction in Children.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003067.html