Meta-analysis of Air Versus Liquid Enema for Intussusception Reduction in Children.
OBJECTIVE
The purpose of this study was to assess the effectiveness and safety of air versus liquid enema reduction in the treatment of intussusception in children.


METHODS
Literature searches of the PubMed, Embase, and Cochrane Library databases were conducted from January 1, 1966, through May 31, 2013. Articles on the use of air or liquid enema in children with a confirmed diagnosis of intussusception and reporting either a success rate for enema reduction of intussusception or a perforation rate were selected. Enema reduction success rate, perforation rate, and recurrence rate were the main outcomes and were calculated by random effects modeling.


RESULTS
One hundred two articles (101 reporting success rate, 71 reporting perforation rate) were included that presented results for 32,451 children (age range, 1 day-22 years; boys, 66%; girls, 34%). In 44 studies (16,187 children), the combined estimate for success rate of air enema was 82.7% (95% CI, 79.9-85.6%; inconsistency index [I(2)] = 97%), and in 52 studies (13,081 children) of liquid enema, it was 69.6% (95% CI, 65.0-74.1%; I(2) = 98%). In 38 studies (15,752 children), the combined estimate of perforation rate for air enema was 0.39% (95% CI, 0.23- 0.55%; I(2) = 40%), and in 30 studies (9429 children) of liquid enema, it was 0.43% (95% CI, 0.24- 0.62%; I(2) = 9%). Among 10,494 children (26 studies) undergoing air enema reduction, the rate of first intussusception recurrence was 6% (95% CI, 4.5-7.5%; I(2) = 89%), similar to the 7.3% (95% CI, 5.8-8.8%; I(2) = 71%) found for 4004 children (24 studies) undergoing liquid enema reduction.


CONCLUSIONS
Air enema was superior to liquid enema for intussusception reduction. The success rate was higher without a difference in perforation rate. Limitations included heterogeneity and publication bias.
1 Department of Radiology, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322.
Gelareh
G
Sadigh
2 Pfizer, Inc, New York, NY.
Kelly H
KH
Zou
3 Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Seyed Amirhossein
SA
Razavi
1 Department of Radiology, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322.
Ramsha
R
Khan
1 Department of Radiology, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322.|4 Department of Radiology, Children's Hospital of Atlanta and Emory University School of Medicine, Atlanta, GA.
Kimberly E
KE
Applegate
D000293:Adolescent; D000388:Air; D002648:Child; D002675:Child, Preschool; D004733:Enema; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007443:Intussusception / Q000628:therapy*
air enema; children; intussusception; liquid enema; meta-analysis