title: An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for pediatric intussusception.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Montreal Children's Hospital, Division of Pediatric General and Thoracic Surgery, Montreal, Quebec, Canada.
authors.forename: Alana L
authors.initials: AL
authors.lastname: Beres
authors.forename: Robert
authors.initials: R
authors.lastname: Baird
mesh_terms: D000293:Adolescent; D000388:Air; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D004733:Enema; D005260:Female; D006801:Humans; D007223:Infant; D007443:Intussusception / Q000628:therapy*; D008297:Male; D017211:Treatment Failure
chemical_list: D003287:Contrast Media