Meyer 1993 examined liquid enema versus air enema; however, not all participants who were initially randomised had intussusception at the time of intervention. It is uncertain whether use of liquid enema plus glucagon improved the rate of successful reduction of intussusception when compared with enema alone because the quality of the evidence is low (reported in two trials, 218 participants; RR 1.09, 95% CI 0.94 to 1.26; I = 0%; Analysis 1.1). Kosloske AM, Intussusception is most commonly encountered in children and has been reported to be the most common abdominal emergency in early childhood and the second most common cause of intestinal obstruction after pyloric stenosis. For children younger than 2, intussusception is the most common abdominal emergency. et al. The ClinicalTrials.gov, Embase, PubMed, and Scopus databases were queried for literature from January 1988 through December 2018. It cuts off the blood supply to the intestines, which can be very dangerous. HHS Vulnerability Disclosure, Help Electronic searches of the Conchrane Central Register of Controlled Trials (n = 59), MEDLINE (n = 307), Embase (n = 140), BIOSIS (n = 94), and the Science Citation Index (n = 158) yielded a total of 758 publications. Frontiers | Colocolic Intussusception in Children: A Case Series and Mulholland K. Clinical case definition for the diagnosis of acute intussusception, Journal of Pediatric Gastroenterology and Nutrition, Paediatric intussusception: epidemiology and outcome. It often occurs near the ileocecal junction and rarely only involves the colon ( 1, 2 ). Huppertz HI, This article focuses on intussusception in children. Bethesda, MD 20894, Web Policies No single study adequately reported all domains of the risk of bias assessment (Figure 2). Holman RC, Rasero M, These situations might reflect missing data, which may have implications for analysis. The site is secure. Patel MM, This review highlights several points that need to be addressed in future studies, including reducing the risk of bias and including relevant outcomes. #6 (infant* or child* or newborn*):ti,ab,kw We judged statistical heterogeneity to be substantial for I values greater than 50% or Chi P values less than 0.10. See summary of findings tables (Table 1; Table 2; Table 3). Repeated enema reductions may be attempted when clinically appropriate. FOIA Bloody stool. Although Cachat found that dexamethasone was beneficial in reducing rates of recurrence of intussusception among children, review findings suggest that risk of recurrence of intussusception is low, and that regardless of the technique used for successful reduction, it is safe to discharge a patient after performing successful reduction. Meyer JS, Intussusception in Children - Stanford Medicine Children's Health Intussusception among infants given an oral rotavirus vaccine, Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients, Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study. GoniOrayen C. Rescue by pneumoenema under general anaesthesia of apparently nonreducible intestinal intussusception, Analyses of air enema and radiographic film for acute intussusception in children, ChungHua i Hsueh Tsa Chih [Chinese Medical Journal], Intravenous glucagon in hydrostatic reduction of intussusception: a controlled study of 63 patients, ChungHua Min Kuo Hsiao Erh Ko i Hsueh Hui Tsa Chih, The role of abdominal radiography in the diagnosis of intussusception when interpreted by pediatric emergency physicians, Ultrasound guided hydrostatic enema in the treatment of pediatric intussusception, Effect of hydrocortisone on improving outcome of pneumatic reduction of infantile intussusception, The effect of midazolam in decreasing time of hydrostatic reduction of childhood intussusceptions, Open reduction of pediatric intussusception through inferior umbilical skin fold incision, Chinese Clinical Trials Registry [Prospective Registration], Comparing several groups using analysis of variance, ACR practice guideline for the performance of paediatric fluoroscopic contrast enema examinations. Ileocolic intussusception is one of the most common abdominal emergencies in children less than three years old [].The reported incidence is .33-.71/1000 person years [2,3].Most cases of intussusception in children have a benign etiology without a pathological lead point; therefore, surgical resection is necessary only in the minority of cases []. Further research is needed to help doctors better understand the most effective way to manage intussusception in children. Liu KW, The outlook is less good if the child is not treated until the condition has become severe and longer-lasting bowel damage has occurred. Two review authors (SG and RGM) independently extracted data and assessed risk of bias using a standardised data extraction form. Specifically, surgical trials are lacking, and future research is needed to address this evidence gap. The remaining studies (three studies for sequence generation and five for allocation concealment) used unclear methods. The study appears to be free of other sources of bias. We analysed data for all participants in the group to which they were allocated, regardless of whether they received the allocated intervention. Intussusception: hospital size and risk of surgery. Lack of trials on surgical management might reflect the nature of treatment of children with intussusception, and might suggest that cases are managed largely by nonsurgical means, although this suggestion does not seem to be based on trial evidence. eCollection 2022. 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 Please see Characteristics of included studies; Characteristics of excluded studies; and Characteristics of ongoing studies. Only one trial reported on postoperative complications (Essa 2011) when comparing use of enema plus dexamethasone versus enema alone. Study design: randomised controlled trial; 2arm study, Study duration: August 2006 until July 2010, Location: Assuit University Children's Hospital, Egypt, Health Status: "clinical features of intussusception", Number (treatment group/control group): 75 (40/35), IM dexamethasone sodium sulphate: 0.5 mg/kg/8 h, immediately before the start of enema reduction and every 8 hours thereafter, for a total of 3 doses, plus nasogastric tube, IV fluids, antibiotics, and ultrasoundguided saline enema reduction, Nasogastric tube, IV fluids, antibiotics, and ultrasoundguided saline enema reduction alone, Complete reduction by ultrasoundguided saline enema, Incidence of recurrence during first 24 hours in hospital and during first week (early recurrence) and 6 months post reduction (late recurrence), Health status: referred for reduction of ileocolic intussusception, Number (treatment group/control group): 30 (15/15), Exclusion criteria: suspicion of attending physician of peritonitis, clinical or radiographic evidence of peritonitis or intestinal perforation, radiographic evidence of smallbowel obstruction, indication that intussusception had been present for over 48 hours, fever over 40 C, hypovolaemic shock, blood loss anaemia (haemoglobin < 80 g/L), contraindication to administration of glucagon (suspected pheochromocytoma, insulinoma, glucagon sensitivity, or uncontrolled diabetes), Glucagon: 0.05 mg/kg with barium enema injected IV (over 1 minute) when intussusception was identified at fluoroscopy, Placebo: 0.05 mg/kg with barium enema injected IV when intussusception was identified at fluoroscopy, Reduction of intussusception by barium enema, Failure of procedure at the end of the time limit, but ultimately successful hydrostatic reduction, Failure of procedure, but intussusception reduced at surgery, Failure of procedure, and intussusception unreduced at surgery, Study design: randomised controlled trial; 3arm study, Study duration: July 1994 until December 1999, Location: Cairo University Childrens Hospital (Abu El Rich), Health status: All patients whose clinical and radiological data confirmed the diagnosis of intussusception were eligible for the study, Number (treatment group/control group): 147 (50/97), Hydrostatic reduction, via liquid enema; 50 participants were allocated to barium enema; 47 were allocated to ultrasoundguided saline enema, Study design: randomised controlled trial, Location: Chang Gung Memorial Hospital, Keelung, Taiwan, Health status: "intussusception patients", Number (treatment/control): 281 (144/137), Dexamethasone sodium phosphate: 0.5 mg/kg injected IM immediately after patient met inclusion criteria, before air enema reduction by radiologist team, Normal saline: 0.5 mg/kg injected IM before air enema reduction by radiologist team, 72 hours post reduction recurrence of intussusception (early recurrence), 1 week post reduction recurrence of intussusception (early recurrence), 6 months post reduction recurrence of intussusception (late recurrence), Study duration: July 1989 until December 1991, Heath status: patient's physicians requested examination to rule out intussusception; 52 of 101 children undergoing investigation had intussusception, Number (treatment 1/treatment 2): 101 (50/51), Exclusion criteria: patient required a specific contrast, refused consent, required a stronger contrast agent to show mucosa, had increased bowel gas, had indications for watersoluble contrast agent (risk of perforation), had recent unsuccessful examination of intussusception, or had a language barrier, Both study groups were prepared in the same manner. Cases assigned even random numbers were to undergo examination with liquid contrast material and those assigned odd random numbers were to be examined with air. This allocation sequence is predictable and is compromised by the need to extrapolate data for participants with confirmed intussusception, No missing data (randomisation post exclusion). As a library, NLM provides access to scientific literature. 2022 Oct;172(13-14):322-326. doi: 10.1007/s10354-022-00915-4. This outcome was not reported in any trial. The authors of the current review could not perform the comparison offered in both Daneman 2003 and Ko 2007 but agree with the findings of Ko 2007, which suggest that lack of standardisation among single studies makes objective comparison difficult. Applegate KE. Vist GE, Seeger JD. Intussusception Symptoms, Treatment, Surgery, Diet, Success 1 or 2 Federal government websites often end in .gov or .mil. 9,10. Who is more likely to get intussusception? #2 Topic=((infant* or child* or newborn*)) Debate persists on specifics regarding what type of substance should be used for the enema, how the substance is visualised during the process, whether extra medications should be given to enhance treatment, and how one should deal with treatment failure, as well as the best approach to surgical management of intussusception in children. Intussusception can be life-threatening and requires immediate treatment. Allen JE, Jordan R. Intussusception: an anatomical perspective with review of the literature. ACW: drafting the protocol and providing methodological advice. Intussusception often involves both small and large bowels. Not all of the studys prespecified primary outcomes have been reported; One or more primary outcomes is reported using measurements, analysis methods or subsets of the data (e.g. Ward JI, Intussusception current trends in management. To deal with clinical heterogeneity, we analysed studies of each intervention and presented them separately. Pellerin M, Comparison 3 Air enema versus liquid enema, Outcome 1 Successfully reduced intussusception. MacCarthy J, Searches for ongoing trials revealed three (El Fiky 2016; Mehraeen 2011; Zhang 2015), for which no results were available. Vomiting. Sadigh G, Prompt diagnosis and management reduces associated risks and the need for surgery. Laparoscopic reduction is often successful. We also examined proceedings from meetings of the British Association of Paedatric Surgeons (BAPS), the American Society of Pediatric Surgery, and the World Congress of Pediatric Surgery (20092015). ((intestin* and invagination*) or intususcep* or intussuscep*).mp. Included trials assessed a wide range of treatments. No trials in this comparison reported on the number of children with bowel perforation(s) nor on the number of children with recurrent intussusception. Sandler AD, The https:// ensures that you are connecting to the Yiltok SJ, Nonsurgical management of intussusception in children consists of contrast enema (Applegate 2009; Daneman 2004; Ito 2012; Ko 2007), which involves instilling contrast medium (i.e. if envelopes were unsealed or nonopaque or not sequentially numbered); Any other explicitly unconcealed procedure. Intussusception (Bowel Obstruction): Treatment & Symptoms Discomfort during doublecontrast barium enema examination: a placebocontrolled doubleblind evaluation of the effect of glucagon and diazepam, Cochrane Handbook for Systematic Reviews of Interventions. After treatment intussusception can come back (recur) - this happens in around 5 children for every 100 who are treated, reducing to 3 if the condition is treated surgically. government site. Beres AL, We did not perform a quantitative analysis of this outcome owing to poor reporting and high risk of bias. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Inpatient Admission versus Emergency Department Management of Intussusception in Children: A Systemic Review and Meta-Analysis of Outcomes. We judged most trials as having high risk of bias in at least one domain, and omissions in methods were evident in all included studies. Indications for laparoscopy in the management of intussusception: a multicenter retrospective study conducted by the French Study Group for Pediatric Laparoscopy (GECI). We identified six randomised studies, with a total of 822 participants, that explored the management of intussusception in children and assessed different types of interventions. However, several narrative reviews have included comparative studies and RCTs (Applegate 2009; Cachat 2012; Daneman 2003; Ko 2007; Sadigh 2015). Bonnard A, Loukas M, Individuals who apply the results of this review need to acknowledge the limitations of available data derived from few trials. The evidence base for this topic is lacking and must be developed further. #2 ((intestin* and invagination*) or intususcep* or intussuscep*):ti,ab,kw Oxman AD, Treatment of intussusception using an air enema Copyright 2020 Elsevier Inc. All rights reserved. PDF Intussusception in Children 3 and 6 3. Tejedor D, This equates to a number needed to treat for an additional beneficial outcome of 13 (95% CI 8 to 37). Three studies found that physicians correctly diagnosed intussusception in less than half of initial clinical encounters (Beasley 1988; Blanch 2007; Budwig 1994). The cause of intussusception is often idiopathic (Staatz 1998), although any condition that produces pathological lead points (lesions in the bowel) can cause intussusception (Loukas 2011). HHS Vulnerability Disclosure, Help Applegate 2009, Cachat 2012, Daneman 2003, Ko 2007, and Sadigh 2015 included no relevant randomised trial that was not included in our review. Intussusception: Symptoms, Causes, Diagnosis & Treatment - Healthline doi: 10.1111/ped.15495. Data for one subgroup of children, specifically those undergoing manual reduction, were not available. Approximately 90% of ileocolic intussusception cases are idiopathic, and most can be resolved by nonoperative reduction with therapeutic enema ( 2, 3 ). Comparative outcome analysis of the management of pediatric intussusception with or without surgical admission, Acute intussusception in infants and children: a global perspective. Ted Gerstle J. Its incidence varies from 0.24 to 2.4 per 1000 live births (Bines 2002; Eng 2012; Fischer 2004; Huppertz 2006; Samad 2014), although evidence suggests that this rate is higher in developing countries (Ugwu 2000). Intussusception - Treatment algorithm | BMJ Best Practice Study authors provided no new information. We judged all included trials to be at risk of bias owing to omissions in reported methods. Interventions: number of participants for each intervention, a detailed description of interventions and comparison interventions including, when relevant, type, dose, concentration, and duration of application. Higgins JP, Symptoms of Intussusception. It is unclear whether this was adequate to ensure random sequence generation in Hadidi 1999; in Meyer 1993, the randomisation process was compromised by the need to extrapolate data for participants with confirmed intussusception; and Mortensson 1984 applied inadequate sequence generation by using birth dates to randomly allocate participants. Halsey N, Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 1 Successfully reduced intussusception. Both quasiRCTs and clusterRCTs were eligible for inclusion. It is important to note that surgical intervention was not the primary study question for any of the included studies. Lappas JC, We obtained only data for the outcomes 'liquid enema plus glucagon versus liquid enema alone' and 'air enema versus liquid enema' from two trials each, and data for all other outcomes from single trials only, most with small sample sizes. We searched the following electronic databases for relevant studies. We conducted subgroup analyses when required to deal with variations in the study population age (Subgroup analysis and investigation of heterogeneity). Boys are affected two to eight times more often than girls (Bines 2002), and peak incidence occurs between five and nine months of age (Daneman 2003; Samad 2012). It is likely that the majority of studies will fall into this category. Filler RM. et al. Goncalves D, Initial treatment includes obtaining adequate intravenous access and correction of hypovolaemia with isotonic fluid resuscitation. Accessibility However, this review included only six trials. Current radiological management of intussusception in children. Air enema may be superior to liquid enema for successfully reducing intussusception in children; however, this finding is based on a few studies including small numbers of participants. Unauthorized use of these marks is strictly prohibited. #4 MeSH descriptor Infant explode all trees Intussusception is the most common cause of intestinal blockage in children between ages 3 months and 3 years. No study reported adequate sequence generation or adequate allocation concealment. Epub 2015 Aug 20. DiazAldagalan GR, Parashar U, This equates to an NNTB of 6 (95% CI 4 to 17). For trials judged to have similar interventions, populations, and outcomes, we used fixedeffect model metaanalysis, as randomeffects models produce poor estimates with small numbers of studies (Higgins 2011), and we considered a P value of 0.05 or less to be statistically significant. Evidence is current to September 2016. Protocol first published: Issue 2, 2007 We included six randomised controlled trials (RCTs) with a total of 822 participants. Two studies reported incomplete outcome data inadequately (Lin 2000; Mortensson 1984), when data were not available for unexplained reasons. Preparation included a nasogastric tube with drainage of the stomach, intravenous fluid deficit replacement, and intravenous metronidazole and cefotaxime, "randomisation was based on a table of random numbers, wherein 15 consecutive random numbers were selected and assigned to cases 1 through 15. Chapter 12: Interpreteing results and drawing conclusions, Higgins JP T, GreenS editor(s). Therefore, we reported four trials as having inadequate blinding of participants and personnel. Evidence from two studies suggests that using air for the enema to reduce intussusception is superior to using liquid for the enema. Gluckman S, Karpelowsky J, Webster AC, McGee RG. Thus data were provided by only one study, and for only a subgroup of children receiving surgical intervention, and data were not sufficient to permit an analysis of this outcome. Insufficient information about the sequence generation process to permit judgement of Low risk or High risk. Although intussusception can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestines. It provides analgesia (Lappas 1995) and reduces colonic muscle tone (Skucas 1994). Irritability. Central allocation (including telephone, webbased and pharmacycontrolled randomization); Sequentially numbered drug containers of identical appearance; Sequentially numbered, opaque, sealed envelopes. In the 'Summary of findings' tables, we included all primary outcomes, as well as secondary outcomes, reported by included studies for the following comparisons: enema plus glucagon versus enema alone; enema plus dexamethasone versus enema alone; and air enema versus liquid enema. Keywords: KL2 TR001854/TR/NCATS NIH HHS/United States, NCI CPTC Antibody Characterization Program. Kulldorff M, Sato K, Till H, The blood supply to the affected part of the intestine can get cut off. Ein SH, Jewett TC Jr. Intussusception: evolution of current management. Inclusion in an NLM database does not imply endorsement of, or agreement with, The role of antibiotics is unclear. This is usually the case if the method of concealment is not described or not described in sufficient detail to allow a definite judgement for example if the use of assignment envelopes is described, but it remains unclear whether envelopes were sequentially numbered, opaque and sealed. Marven S, Intussusception (in-tuh-suh-SEP-shun) happens when one part of the bowel slides into the next, much like the pieces of a telescope. We could not assess publication bias as planned because of the small number of included studies. Food . Rothstein HR. Podevin G, We planned to perform sensitivity analyses using risk of bias as one of the sensitivity factors (see Subgroup analysis and investigation of heterogeneity). We included all randomised controlled trials comparing contrast media, imaging modalities, pharmacological adjuvants, protocols for delayed repeat enema, and/or surgical approaches for the management of intussusception in children. It is a bit like a getting a sock turned inside itself. Goldman HS. 19. If we identified cluster trials, we planned to involve a statistician to ensure that we did not create unit of analysis errors.
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