title: Recurrence rates after intussusception enema reduction: a meta-analysis.
abstract: OBJECTIVE
  Reported rates of recurrence after enema reduction for intussusception are variable. Concerns for recurrence influence postreduction management. The objective of this study was to conduct a systematic review and meta-analysis to estimate overall, 24-hour, and 48-hour recurrence rates after enema reduction in children.
  
  
  METHODS
  PubMed, Cochrane Database, and OVID Medline were searched from 1946 through December 2011 using the search terms: intussusception, recurrence, and enema. Sixty-nine studies of patients age 0 to 18 years with radiographically proven intussusception reduced by enema that report the number of enema reductions and the number of recurrences were included. Extraction was done by the primary author (M.P.G.) with 10% of included studies independently audited to ensure concordance.
  
  
  RESULTS
  Overall recurrence rates were 12.7% (95% confidence interval [CI]: 11.1%-14.4%, I2 = 28.8%) for contrast enema (CE), 7.5% (95% CI: 5.7%-9.8%, I2 = 52.4%) for ultrasound-guided noncontrast enema (UGNCE), and 8.5% (95% CI: 6.9%-10.4%, I2 = 50.1%) for fluoroscopy-guided air enema (FGAE). Recurrence rates within 24 hours were 3.9% (95% CI: 2.2%-6.7%, I2 = 47.0%) for CE, 3.9% (95% CI: 1.5%-10.1%, I2 = 0.0%) for UGNCE, and 2.2% (95% CI: 0.7%-6.5%, I2 = 59.8%) for FGAE. Recurrence rates within 48 hours were 5.4% (95% CI 3.7%-7.8%, I2 = 32.3%) for CE, 6.6% (95% CI: 4.0%-10.7%, I2 = 0.0%) for UGNCE, and 2.7% (95% CI: 1.2%-6.5%, I2 = 73.8%) for FGAE. Most included studies are retrospective and vary in quality of reporting. Few studies reported detailed patient characteristics including timing of recurrences.
  
  
  CONCLUSIONS
  The risk of early (within 48 hours) recurrence after enema reduction is low, suggesting outpatient management of well-appearing patients should be considered.
authors.affiliation: Sections of Emergency Medicine, and mgray@mcw.edu.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Gray
authors.affiliation: Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WisconsinQuantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and.
authors.forename: Shun-Hwa
authors.initials: SH
authors.lastname: Li
authors.affiliation: Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WisconsinQuantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and.
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Hoffmann
authors.affiliation: Sections of Emergency Medicine, andChildren's Research Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Marc H
authors.initials: MH
authors.lastname: Gorelick
mesh_terms: D002648:Child; D004733:Enema; D006801:Humans; D007077:Ileal Diseases / Q000628:therapy*; D007443:Intussusception / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
keywords: enema; intussusception; recurrence