Scolaris Content Display Scolaris Content Display

مدیریت درهم‌تو‌‌رفتگی (intussusception) روده در کودکان

Contraer todo Desplegar todo

Referencias

Essa 2011 {published data only}

Essa AE, Eltayeb AA, Mansour E. Evaluation of the role of dexamethasone in decreasing early recurrence of intussusception: using ultrasound‐guided saline enema for reduction. Surgical Practice 2011;15(4):114‐9. CENTRAL

Franken 1983 {published data only}

Franken, EA, Smith WL, Chernish SM, Campbell JB, Fletcher BD, Goldman HS. The use of glucagon in hydrostatic reduction of intussusception: a double‐blind study of 30 patients. Radiology 1983;146(3):687‐9. [Accession Number: CN‐00030376; PUBMED: 6828682]CENTRAL

Hadidi 1999 {published data only}

Hadidi AT, El Shal N. Childhood intussusception: a comparative study of nonsurgical management. Journal of Pediatric Surgery 1999;34(2):304‐7. CENTRAL

Lin 2000 {published data only}

Lin SL, Kong MS, Houng DS. Decreasing early recurrence rate of acute intussusception by the use of dexamethasone. European Journal of Pediatrics 2000;159(7):551‐2. [PUBMED: 10923238]CENTRAL
Lin SL, Kong MS, Huong D. Decrease early recurrence rate of childhood acute intussusception by dexamethasone. Proceedings from The 11th Asia Pacific Congress of Doppler Echocardiography and 8th APCDE. New Dehli, India, November 26‐27, 2005. CENTRAL

Meyer 1993 {published data only}

Meyer JS, Dangman BC, Buonomo C, Berlin JA. Air and liquid contrast agents in the management of intussusception: a controlled, randomized trial. Radiology 1993;188(2):507‐11. [PUBMED: 8327705]CENTRAL

Mortensson 1984 {published data only}

Mortensson W, Eklof O, Laurin S. Hydrostatic reduction of childhood intussusception. The role of adjuvant glucagon medication. Acta Radiologica: Diagnosis 1984;25(4):261‐4. CENTRAL

Diaz‐Aldagalan 2012 {published data only}

Diaz‐Aldagalan GR, Perez‐Martinez A, Pison‐Chacon J, Ayuso‐Gonzalez L, Salcedo‐Munoz B, Goni‐Orayen C. Rescue by pneumoenema under general anaesthesia of apparently non‐reducible intestinal intussusception. European Journal of Pediatrics 2012;171(1):189‐91. CENTRAL

Guo 2010 {published data only}

Guo WL, Zhou M, Wang J, Sheng M. Analyses of air enema and radiographic film for acute intussusception in children. Chung‐Hua i Hsueh Tsa Chih [Chinese Medical Journal] 2010;90(47):3359‐61. CENTRAL

Hsiao 1988 {published data only}

Hsiao JY, Kao HA, Shih SL. Intravenous glucagon in hydrostatic reduction of intussusception: a controlled study of 63 patients. Chung‐Hua Min Kuo Hsiao Erh Ko i Hsueh Hui Tsa Chih 1988;29(4):242‐7. CENTRAL

Morrison 2009 {published data only}

Morrison J, Lucas N, Gravel J. The role of abdominal radiography in the diagnosis of intussusception when interpreted by pediatric emergency physicians. Journal of Pediatrics 2009;155(4):556‐9. CENTRAL

Zhang 2014 {published data only}

Zhang PJ, Wang LY, Zhang Z. Ultrasound guided hydrostatic enema in the treatment of pediatric intussusception. Journal of Dallan Medical University 2014;36(4):365‐6, 379. CENTRAL

El Fiky 2016 {published data only}

El Fiky M. Effect of hydrocortisone on improving outcome of pneumatic reduction of infantile intussusception. clinicaltrials.gov/show/NCT02691858. CENTRAL

Mehraeen 2011 {unpublished data only}

Mehraeen R. The effect of midazolam in decreasing time of hydrostatic reduction of childhood intussusceptions. Iranian Registry of Clinical Trials. CENTRAL

Zhang 2015 {published data only}

Zhang W, Ning L. Open reduction of pediatric intussusception through inferior umbilical skin fold incision. Chinese Clinical Trials Registry [Prospective Registration] 26 April 2014. CENTRAL

Altman 1996

Altman DG, Bland JM. Comparing several groups using analysis of variance. BMJ 1996;312(7044):1472‐3. [PMID: 8664633]

American College of Radiology 2007

American College of Radiology. ACR practice guideline for the performance of paediatric fluoroscopic contrast enema examinations. http://www.acr.org (last accessed 15 May 2012). 2007 [Revised 2011].

Applegate 2009

Applegate KE. Intussusception in children: evidence‐based diagnosis and treatment. Pediatric Radiology 2009;39:140‐3. [PMID: 19308373]

Bailey 2007

Bailey KA, Wales PW, Gerstle JT. Laparoscopic versus open reduction of intussusception in children: a single‐institution comparative experience. Journal of Pediatric Surgery 2007;42(5):845‐8.

Beasley 1988

Beasley SW, Auldist AW, Stokes KB. The diagnostically difficult intussusception: its characteristics and consequences. Pediatric Surgery International 1988;3:135‐8. [DOI: 10.1007/BF00182768]

Beasley 1998

Beasley SW, Myers NA. Intussusception: current views. Pediatric Surgery International 1998;14(3):157‐62. [DOI: 10.1007/s003830050473]

Beres 2014

Beres AL, Baird R, Fung E, Hsieh H, Abou‐Khalil M, Ted Gerstle J. Comparative outcome analysis of the management of pediatric intussusception with or without surgical admission. Journal of Pediatric Surgery 2014;49(5):750‐2. [DOI: http://dx.doi.org/10.1016/j.jpedsurg.2014.02.059]

Bines 2002

Bines JE, Ivanoff B. Acute intussusception in infants and children: a global perspective. A report prepared for the Steering Committee on Diarrhoeal Disease Vaccines, Vaccine Development,Vaccines and Biologicals, World Health Organization, Geneva, Switzerland. Vaccines and Biologicals2002; Vol. WHO V & B:02.19.

Bines 2004a

Bines JE,  Kohl KS,  Forster J,  Zanardi LR,  Davis RL,  Hansen J,  et al. Acute intussusception in infants and children as an adverse event following immunization: case definition and guidelines of data collection, analysis, and presentation. Vaccine 2004;22(5‐6):569‐74. [PMID: 14741146]

Bines 2004b

Bines JE,  Ivanoff B,  Justice F,  Mulholland K. Clinical case definition for the diagnosis of acute intussusception. Journal of Pediatric Gastroenterology and Nutrition 2004;39(5):511‐8. [PMID: 15572891]

Blanch 2007

Blanch AJ,  Perel SB,  Acworth JP. Paediatric intussusception: epidemiology and outcome. Emergency Medicine Australasia 2007;19(1):45‐50. [PMID: 17305660]

Bonnard 2008

Bonnard A, Demarche M, Dimitriu C, Podevin G, Varlet F, François M, et al. Indications for laparoscopy in the management of intussusception: a multicenter retrospective study conducted by the French Study Group for Pediatric Laparoscopy (GECI). Journal of Pediatric Surgery 2008;43(7):1249‐53.

Borenstein 2009

Borenstein M, Hedges L, Higgins JPT, Rothstein HR. Introduction to Meta‐analysis. Chichester, U.K.: John Wiley & Sons, 2009.

Bratton 2001

Bratton SL,  Haberkern CM,  Waldhausen JH,  Sawin RS,  Allison JW. Intussusception: hospital size and risk of surgery. Pediatrics 2001;107(2):299‐303. [PMID: 11158462]

Bruce 1987

Bruce J, Huh YS, Cooney DR, Karp MP, Allen JE, Jewett TC. Intussusception: evolution of current management. Journal of Pediatric Gastroenterology and Nutrition 1987;6:663‐4. [PMID: 3320323]

Budwig 1994

Budwig K, Rothrock SG, Sudhipong V, Falk JL, Molpus B, Perlman R. Misdiagnosis of pediatric intussusception. Annals of Emergency Medicine 1994;23(3):611‐2. [DOI: 10.1016/S0196‐0644(94)80309‐9]

Buttery 2011

Buttery JP,  Danchin MH,  Lee KJ,  Carlin JB,  McIntyre PB,  Elliott EJ,  et al. Intussusception following rotavirus vaccine administration: post‐marketing surveillance in the National Immunization Program in Australia. Vaccine 2011;29(16):3061‐6. [PMID: 21316503]

Cachat 2012

Cachat F, Ramseyer P. Question 3: Does the administration of glucagon improve the rate of radiological reduction in children with acute intestinal intussusception?. Archives of Disease in Childhood 2012;97:389‐91. [DOI: 10.1136/archdischild‐2012‐301763]

Calder 2001

Calder FR,  Tan S,  Kitteringham L,  Dykes EH. Patterns of management of intussusception outside tertiary centres. Journal of Pediatric Surgery 2001;36(2):312‐5. [PMID: 11172423]

Daneman 2003

Daneman A,  Navarro O. Intussusception, Part 1: A review of diagnostic approaches. Pediatric Radiology 2003;33(2):79‐85. [PMID: 12557062]

Daneman 2004

Daneman A, Navarro O. Intussusception, Part 2: An update on the evolution of management. Pediatric Radiology 2004;34(2):97‐108. [PMID: 14634696]

Davis 2003

Davis CF, McCabe AJ, Raine PA. The ins and outs of intussusception: history and management over the past fifty years. Journal of Pediatric Surgery 2003;38:60‐4.

del‐Pozo 1999

del‐Pozo G, Albillos JC, Tejedor D, Calero R, Rasero M, de‐la‐Calle U, et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics 1999;19(2):299‐319. [PMID: 10194781]

Desai 2012

Desai R,  Curns AT,  Patel MM,  Parashar UD. Trends in intussusception‐associated deaths among US infants from 1979‐2007. Journal of Pediatrics 2012;160(3):456‐60. [PMID: 21925681]

Ein 2006

Ein SH, Daneman A. Intussusception. In: Grosfeld L, O'Neill JA, Fonkalsrud EW, Coran AG editor(s). Pediatric Surgery. Philadelphia: Mosby‐Elsevier, 2006:1313–41.

Eng 2012

Eng PM,  Mast TC,  Loughlin J,  Clifford CR,  Wong J,  Seeger JD. Incidence of intussusception among infants in a large commercially insured population in the United States. Pediatric Infectious Disease Journal 2012;31(3):287‐91. [PMID: 22173141]

Fischer 2004

Fischer TK,  Bihrmann K,  Perch M,  Koch A,  Wohlfahrt J,  Kåre M,  et al. Intussusception in early childhood: a cohort study of 1.7 million children. Pediatrics 2004;114(3):782‐5. [PMID: 15342854]

Gonzalez‐Spinola 1999

Gonzalez‐Spinola J, Del Pozo G, Tejedor D, Blanco A. Intussusception: the accuracy of ultrasound guided saline enema and the usefulness of a delayed attempt at reduction. Journal of Pediatric Surgery 1999;34:1016‐20.

Gray 2014

Gray MP, Li SH, Hoffman RG, Gorelick MH. Recurrence rates after intussusception enema reduction: a meta‐analysis. Pediatrics 2014;134(1):110‐9.

Higgins 2003

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60.

Higgins 2011

Higgins JP, Green S, editors(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. handbook.cochrane.org.

Huppertz 2006

Huppertz HI,  Soriano‐Gabarró M,  Grimprel E,  Franco E,  Mezner Z,  Desselberger U,  et al. Intussusception among young children in Europe. Pediatric Infectious Disease Journal 2006;25(1 Suppl):S22‐9. [PMID: 16397426]

Hviid 2009

Hviid A, Svanström H. Antibiotic use and intussusception in early childhood. Journal of Antimicrobial Chemotherapy 2009;64(3):642‐8.

Ito 2012

Ito Y,  Kusakawa I,  Murata Y,  Ukiyama E,  Kawase H,  Kamagata S, et al. Japanese guidelines for the management of intussusception in children, 2011. Pediatrics International2012; Vol. Epub ahead of print. [DOI: 10.1111/j.1442‐200X.2012.03622.x.]

Iwase 2010

Iwase H, Motani H, Yajima D, Hayakawa M, Kobayashi K, Sato K, et al. Two infant deaths linked to intussusception without peritonitis. Japanese Society of Legal Medicine 2010;12(3):151‐3. [PMID: 20304696]

Jiang 2013

Jiang J, Jiang B, Parashar U, Nguyen T, Bines J, Patel MM. Childhood intussusception: a literature review. PLoS One 2013;8(7):e68482.

Katz 1992

Katz ME, Kolm P. Intussusception reduction 1991: an international survey of pediatric radiologists. Pediatric Radiology 1992;22:318‐22.

Kia 2005

Kia KF, Mony VK, Drongowski RA, Golladay ES, Geiger JD, Hirschl RB, et al. Laparoscopic vs open surgical approach for intussusception requiring operative intervention. Journal of Pediatric Surgery 2005;40(1):281‐4.

Ko 2007

Ko HS, Schenk JP, Tröger J, Rohrschneider WK. Current radiological management of intussusception in children. European Radiology 2007;17(9):2411‐21. [PMID: 17308922]

Kohl 2008

Kohl KS,  Magnus M,  Ball R,  Halsey N,  Shadomy S,  Farley TA. Applicability, reliability, sensitivity, and specificity of six Brighton Collaboration standardized case definitions for adverse events following immunization. Vaccine 2008;26(50):6349‐60. [PMID: 18805456]

Kramarz 2001

Kramarz P, France EK, Destefano F, Black SB, Shinefield H, Ward JI, et al. Population‐based study of rotavirus vaccination and intussusception. Pediatric Infectious Disease Journal 2001;20(4):410‐6. [PMID: 11332666]

Lappas 1995

Lappas JC, Maglinte DD, Chernish SM, Hage JP, Kelvin FM. Discomfort during double‐contrast barium enema examination: a placebo‐controlled double‐blind evaluation of the effect of glucagon and diazepam. Radiology 1995;197:95–9.

Lefebvre 2011

Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.

Lehnert 2009

Lehnert T,  Sorge I,  Till H,  Rolle U. Intussusception in children ‐ clinical presentation, diagnosis and management. The International Journal of Colorectal Disease 2009 ;24(10):1187‐92. [PMID: 19418060]

Littlewood 1998

Littlewood Teele R,  Vogel SA. Intussusception: the paediatric radiologist's perspective. Pediatric Surgery International 1998;14(3):158‐62. [PMID: 9880736]

Liu 1986

Liu KW, MacCarthy J, Guiney EJ, Fitzgerald RJ. Intussusception ‐ current trends in management. Archives of Disease in Childhood 1986;61:75‐7.

Loukas 2011

Loukas M, Pellerin M, Kimball Z, de la Garza‐Jordan J, Tubbs RS, Jordan R. Intussusception: an anatomical perspective with review of the literature. Clinical Anatomy 2011;24:552‐61.

Meier 1996

Meier DE,  Coln CD,  Rescorla FJ,  OlaOlorun A,  Tarpley JL. Intussusception in children: international perspective. World Journal of Surgery 1996;20(8):1035‐9. [PMID: 8798362]

Meyer 1992

Meyer JS. The current radiologic management of intussusception: a survey and review. Pediatric Radiology 1992;22:323–5.

Moss 2000

Moss RL, Skarsgard ED, Kosloske AM, Smith BM. Case Studies in Pediatric Surgery. New York: McGraw‐Hill, 2000.

Murphy 2001

Murphy TV, Gargiullo PM, Massoudi MS, Nelson DB, Jumaan AO, Okoro CA, et al. Intussusception among infants given an oral rotavirus vaccine. New England Journal of Medicine 2001;344(8):564‐72. [PMID: 11207352]

Navarro 2004

Navarro OM, Daneman A, Chae A. Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients. Pediatric Radiology 2004;182(5):1169‐76. [PMID: 15100113]

Nylund 2010

Nylund CM,  Denson LA,  Noel JM. Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study. Journal of Pediatrics 2010;156(5):761‐5. [PMID: 20138300]

Okimoto 2011

Okimoto S,  Hyodo S,  Yamamoto M,  Nakamura K,  Kobayashi M. Association of viral isolates from stool samples with intussusception in children. International Journal of Infectious Diseases 2011;15(9):641‐5. [PMID: 21757385]

Parashar 2000

Parashar UD,  Holman RC,  Cummings KC,  Staggs NW,  Curns AT,  Zimmerman CM. Trends in intussusception‐associated hospitalizations and deaths among US infants. Pediatrics 2000;106(6):1413‐21. [PMID: 11099597]

Pepper 2012

Pepper VK, Stanfill AB, Pearl RH. Diagnosis and management of pediatric appendicitis, intussusception, and meckel diverticulum. Surgical Clinics of North America 2012;92(3):505‐26. [PMID: 22595706 ]

Peter 2002

Peter G, Myers MG. Intussusception, rotavirus, and oral vaccines: summary of a workshop. Pediatrics 2002;110:e67.

RevMan 2014 [Computer program]

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Rosenfeld 1999

Rosenfeld K, McHugh K. Survey of intussusception reduction in England, Scotland and Wales: how and why we could do better. Clinical Radiology 1999;54(7):452‐8. [PMID: 10437697]

Sadigh 2015

Sadigh G, Zou KH, Razavi SA, Khan R, Applegate KE. Meta‐analysis of air versus liquid enema for intussusception reduction in children. American Journal of Roentgenology 2015;205(5):542‐9.

Samad 2012

Samad L, Marven S, El Bashir H, Sutcliffe AG, Cameron JC, Lynn R, et al. Prospective surveillance study of the management of intussusception in UK and Irish infants. British Journal of Surgery 2012;99(3):411‐5. [DOI: 10.1002/bjs.7821]

Samad 2014

Samad L. Epidemiology of intussusception in children: national surveillance and use of record linkage to validate the incidence, and study of incidence trends [Doctoral Thesis]. London (UK): University College London, 2014.

Sandler 1999

Sandler AD, Ein SH, Connolly B, Daneman A, Filler RM. Unsuccessful air‐enema reduction of intussusception: is a second attempt worthwhile?. Pediatric Surgery International 1999;15(3‐4):214‐6.

Schmit 1999

Schmit P,  Rohrschneider WK,  Christmann D. Intestinal intussusception survey about diagnostic and non‐surgical therapeutic procedures. Pediatric Radiology 1999;29(10):752‐61. [PMID: 10525783]

Schünemann 2008

Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, Guyatt GH. Chapter 12: Interpreteing results and drawing conclusions. Higgins JP T, GreenS editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Chichester (UK): John Wiley & Sons, 2008.

Singer 2016

Singer M, Deutschman CS, Seymour CW. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis‐3). JAMA 2016;315(8):801‐10.

Sklar 2014

Sklar CC, Nasr EA. Laparoscopic versus open reduction of intussusception in children: a retrospective review and meta‐analysis. Journal of Laparoendoscopic & Advanced Surgical Techniques 2014;24(7):518‐22. [DOI: 10.1089/lap.2013.0415]

Skucas 1994

Skucas J. The use of antispasmodic drugs during barium enemas. American Journal of Roentgenology 1994;162:1323–5.

Soares‐Weiser 2004

Soares‐Weiser K, Goldberg E, Tamimi G, Pitan OC, Leibovici L. Rotavirus vaccine for preventing diarrhoea. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD002848.pub2]

Somekh 1996

Somekh E, Serour F, Goncalves D, Gorenstein A. Air enema for reduction of intussusception in children: risk of bacteremia. Radiology 1996;200(1):217‐8.

Spiro 2003

Spiro DM, Arnold DH, Barbone F. Association between antibiotic use and primary idiopathic intussusception. Archives of Pediatrics & Adolescent Medicine 2003;157(1):54‐9.

Staatz 1998

Staatz G,  Alzen G,  Heimann G. Intestinal infection, the most frequent cause of invagination in childhood: results of a 10‐year clinical study [Darminfektion, die häufigste Invaginationsursache im Kindesalter: Ergebnisse einer 10jährigen klinischen Studie]. Klinische Pädiatrie 1998;210(2):61‐4. [PMID: 9561958]

Tapiainen 2006

Tapiainen T,  Bär G,  Bonhoeffer J,  Heininger U. Evaluation of the Brighton Collaboration case definition of acute intussusception during active surveillance. Vaccine 2006;24(9):1483‐7. [PMID: 16226829 ]

Ugwu 2000

Ugwu BT,  Legbo JN,  Dakum NK,  Yiltok SJ,  Mbah N,  Uba FA. Childhood intussusception: a 9‐year review. Annals of Tropical Paediatrics 2000;20(2):131‐5. [PMID: 10945064]

Weintraub 2014

Yin K, Lieu T, Kulldorff M, Martin D, McMahill‐Walraven C, Platt R, et al. Intussusception risk after rotavirus vaccination in U.S. infants. The New England Journal of Medicine 2014;370:503‐12. [DOI: 10.1056/NEJMoa1303164]

Wong 2006

Wong SS,  Wilczynski NL,  Haynes RB. Developing optimal search strategies for detecting clinically sound treatment studies in EMBASE. Journal of the Medical Library Association 2006;94(1):41‐7. [PMID: 16404468 ]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Essa 2011

Methods

  • Study design: randomised controlled trial; 2‐arm study

  • Study duration: August 2006 until July 2010

Participants

  • Setting: single‐centre study

  • Location: Assuit University Children's Hospital, Egypt

  • Health Status: "clinical features of intussusception"

  • Number (treatment group/control group): 75 (40/35)

  • Age: 5 to 24 months

  • Sex (M/F): 59/16

Exclusion criteria: pathological lead points, late neglected intestinal obstruction, bowel perforation or shock

Interventions

Treatment group

  • 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 ultrasound‐guided saline enema reduction

Control group

  • Nasogastric tube, IV fluids, antibiotics, and ultrasound‐guided saline enema reduction alone

Outcomes

  • Complete reduction by ultrasound‐guided saline enema

  • Incidence of recurrence during first 24 hours in hospital and during first week (early recurrence) and 6 months post reduction (late recurrence)

Notes

Procedure details: The technique of ultrasound‐guided saline enema reduction involved the following: "a reservoir filled with warm, normal saline was placed at a maximum height of 120cm above the table, with its upper end opened connected to a 10‐18‐Fr Foley's catheter." The enema could be repeated twice more, after a 30‐minute rest, if the initial attempt failed (i.e. lack of reduction within 5 minutes)

The ratio of participants requiring non‐surgical reduction to those requiring surgical reduction was 60:15. In other words, 4/5 participants had successful reduction achieved with non‐surgical techniques

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

“The cases were randomly classified into two groups…”. No further details supplied

Allocation concealment (selection bias)

Unclear risk

“The cases were randomly classified into two groups…”. No further details supplied

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All 75 cases were reported, including those that failed initial intervention: "Cases who failed ultrasound guided saline enema reduction underwent surgical exploration, with operative details and postoperative complications also reported"

Selective reporting (reporting bias)

Low risk

Study includes all expected outcomes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No placebo treatment used in control group

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not specified who assessed outcomes

Franken 1983

Methods

  • Study design: randomised controlled trial; 2‐arm study

  • Study duration: not stated

Participants

  • Setting: not stated

  • Location: not stated

  • Health status: referred for reduction of ileocolic intussusception

  • Number (treatment group/control group): 30 (15/15)

  • Age: 3 years or younger

  • Sex (M/F): not stated

  • Exclusion criteria: suspicion of attending physician of peritonitis, clinical or radiographic evidence of peritonitis or intestinal perforation, radiographic evidence of small‐bowel 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)

Interventions

Treatment group

  • Glucagon: 0.05 mg/kg with barium enema injected IV (over 1 minute) when intussusception was identified at fluoroscopy

Control group

  • Placebo: 0.05 mg/kg with barium enema injected IV when intussusception was identified at fluoroscopy

Outcomes

  • 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 un‐reduced at surgery

Notes

Procedure details: The enema consisted of barium sulphate suspension of approximately 20% w/v concentration, with the enema bag 1 metre above the table top. The enema could be repeated twice more if the initial attempt failed (i.e. lack of reduction within 5 minutes)

Other details: Glucagon and placebo were supplied by the Eli Lilly Company

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

"The injections were given in randomized, double‐blind fashion"; no further details supplied

Allocation concealment (selection bias)

Unclear risk

"The injections were given in randomized, double‐blind fashion"; no further details supplied

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No missing data (randomisation post exclusion)

Selective reporting (reporting bias)

Low risk

Reporting included all outcomes and explained outcomes that were unexpected: "eight of 15 intussusceptions...were successfully reduced" ‐ "two patients in the study suffered complications of intussusception...before full recovery ensued"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

"The injections were given in randomized, double‐blind fashion...Glucagon and the placebo were supplied in identical vials"

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not specified who assessed outcomes

Hadidi 1999

Methods

  • Study design: randomised controlled trial; 3‐arm study

  • Study duration: July 1994 until December 1999

Participants

  • Setting: single‐centre study

  • Location: Cairo University Children’s 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)

  • Mean age, months (SD):

    • Treatment 1: 15 (12)

    • Treatment 2 (barium/saline): 17 (16)/16 (15)

  • Sex (M/F): 93/54

Exclusion criteria: more than 48 hours of symptoms, general or abdominal signs of toxicity, peritonism or peritonitis, or unreasonable electrolyte levels

Interventions

Participants were prepared in the same manner. Preparation included a nasogastric tube with drainage of the stomach, intravenous fluid deficit replacement, and intravenous metronidazole and cefotaxime

All air insufflations were performed by the paediatric surgeon, who was experienced in the technique, and all barium and saline reductions were done by the radiologist, who was experienced in those 2 techniques

Treatment 1

  • Pneumatic reduction via air enema

Treatment 2

  • Hydrostatic reduction, via liquid enema; 50 participants were allocated to barium enema; 47 were allocated to ultrasound‐guided saline enema

Outcomes

  • Amount of fluoroscopic time

  • Rate of successful reduction

Notes

Procedure details: Diagnosis and treatment were provided by a dedicated “intussusception clinical team,” consisting of a single paediatric surgeon, a single paediatric radiologist, and 3 residents; all data were recorded on a specially designed protocol sheet

The study protocol allowed a maximum of 3 attempts at reduction for each participant. An attempt was defined as pneumatic or hydrostatic pressure for 5 minutes

Barium enemas were prepared by routine methods

During enemas administered with liquid contrast material, the top of the bag of liquid contrast agent could be raised to a maximum of 1.5 m above the table top. For air insufflation, the maximum pressure used was 120 mmHg. After 3 unsuccessful attempts, the examination was considered a failure. No sedation was used

Sonographic criteria for successful reduction were disappearance of intussusception and visualisation of passage of fluid and air bubbles from the caecum well into the terminal ileum. After successful reduction, saline solution was replaced by gastrografin, and a single abdominal radiograph was taken again to document the successful reduction

Other details: All air reductions and barium reductions were performed with a GE DRS Prestilix 1600X x‐ray machine. All saline reductions were done under sonographic guidance with Tochiba SSA 140 ultrasound machine

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

"...randomisation was based on a table of random numbers, wherein 15 consecutive random numbers were selected and assigned to cases 1 through 15. This list of 15 cases was used repeatedly throughout the study (10 times) with random sequence every time.” This allocation sequence is predictable

Allocation concealment (selection bias)

High risk

"...randomisation was based on a table of random numbers, wherein 15 consecutive random numbers were selected and assigned to cases 1 through 15. This list of 15 cases was used repeatedly throughout the study (10 times) with random sequence every time.” This allocation sequence is predictable

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No missing data (randomisation post exclusion). “Only 76 patients came to follow up examinations”; however these data were not used in this review

Selective reporting (reporting bias)

Unclear risk

No protocol available

Blinding of participants and personnel (performance bias)
All outcomes

High risk

By definition, the paediatric surgeon or radiologist was aware of the procedure each was conducting

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Outcome assessment involved a treating surgeon or radiologist capable of interpreting sonographic criteria for successful reduction (disappearance of intussusception and visualisation of the passage of fluid and air bubbles from the caecum well into the terminal ileum)

Lin 2000

Methods

  • Study design: randomised controlled trial

  • Study duration: not stated

Participants

  • Setting: single‐centre study

  • Location: Chang Gung Memorial Hospital, Keelung, Taiwan

  • Health status: "intussusception patients"

  • Number (treatment/control): 281 (144/137)

  • Mean age:

    • Treatment group: 18.2 months ± 5.1

    • Control group: 20.3 months ± 4.7

  • Sex (M/F):

    • Treatment group: 96/48

    • Control group: 99/38

  • Exclusion criteria: not stated

Interventions

Treatment group

  • Dexamethasone sodium phosphate: 0.5 mg/kg injected IM immediately after patient met inclusion criteria, before air enema reduction by radiologist team

Control group

  • Normal saline: 0.5 mg/kg injected IM before air enema reduction by radiologist team

Outcomes

  • Initial successful reduction

  • 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)

Notes

Procedure details: no details on procedure provided

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

"We designed a randomised, double‐blind study"

Allocation concealment (selection bias)

Unclear risk

"We designed a randomised, double‐blind study"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Data on participants lost to follow‐up not reported

Selective reporting (reporting bias)

Unclear risk

Method of data collection post discharge not reported

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

"We designed a randomised, double‐blind study”

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

It was not specified who assessed outcomes

Meyer 1993

Methods

  • Study design: randomised controlled trial; 2‐arm study

  • Study duration: July 1989 until December 1991

Participants

  • Setting: single‐centre study

  • Location: Children's Hospital, Boston

  • 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)

  • Mean age:

    • Treatment group 1: 17 months ± 16

    • Treatment group 2: 15 months ± 12

  • Sex (M/F):

    • Treatment group 1: 30/20

    • Treatment group 2: 34/17

  • Exclusion criteria: patient required a specific contrast, refused consent, required a stronger contrast agent to show mucosa, had increased bowel gas, had indications for water‐soluble contrast agent (risk of perforation), had recent unsuccessful examination of intussusception, or had a language barrier

Interventions

  • Both study groups were prepared in the same manner. Sedation was usually achieved with IV pentobarbital sodium (Abbott Labaratories, North Chicago, Illinois), but occasionally with IM meperidine HCL (Sanofi Winthrop, New York, New York) given alone or in combination with IV pentobarbital sodium. A Foley catheter was inserted, and a balloon was inflated in the rectum

Treatment group 1

  • Hydrostatic reduction via liquid enema (barium or water‐soluble contrast media) at the radiologist's discretion

Treatment group 2

  • Pneumatic reduction via air enema

Outcomes

  • Confirmation of intussusception

  • Rate of successful intussusception reduction

  • Recurrence of intussusception

  • Fluoroscopy time

Notes

Procedure details: During the first 1.5 years of the study, barium was the only liquid contrast agent used. During the final year, owing to evolving concepts in intussusception management and changes in personnel, the type of liquid contrast material (water‐soluble or barium) used was determined at the radiologist's discretion

The study protocol allowed a maximum of 3 attempts at reduction for each participant. An attempt was defined as pneumatic or hydrostatic pressure applied for a total of 5 minutes. After 3 unsuccessful attempts, the examination was considered a failure

The concentration of barium used in individual cases was not recorded

Cysto‐Conray II (Iothalamate meglumine 17.2%; Mallinckrodt Medical, St Louis, Missouri) was the water‐soluble enema administered

The air insufflation device included an electronic pop‐off valve that could be set to pressure of 60, 80, or 120 mmHg

Other details: This study examined the accuracy of diagnosis with air versus liquid enema, and thus included participants who did not have intussusception. It was necessary to extrapolate the data of those who did have confirmed intussusception for our review

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

”Randomization was based on a table of random numbers, wherein 20 consecutive random numbers were selected and assigned to cases 1 through 20. 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

Allocation concealment (selection bias)

High risk

Central randomisation table (n = 20)

Used repeatedly throughout the study. Repetative use of the random number table may have allowed prediction of intervention for participants

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No missing data (randomisation post exclusion). Successful diagnosis of intussusception not significantly different between air and liquid contrast groups

Selective reporting (reporting bias)

Unclear risk

No protocol available. Not all expected outcomes were reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

By definition, the radiologist was aware of the procedure he was conducting

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Radiologist who conducted the procedure recorded results

Mortensson 1984

Methods

  • Study design: quasi‐randomised controlled trial (allocation via date of birth); 2‐arm study

  • Study duration: not stated

Participants

  • Setting: not stated

  • Location: St Goran's Children's Hospital, Stockholm, Sweden

  • Health status: intussusception radiologically confirmed by barium enema

  • Number (treatment/control): 188 (69/119)

  • Age (median): 1 month to 5 ½ years (9 months)

  • Sex (M/F): not stated

  • Exclusion criteria: intestinal obstruction and clinical suspicion of bowel gangrene, clinical and radiological manifestations of peritonitis, high fever with gross bowel obstruction

Interventions

  • Following diagnosis by barium enema, groups were allocated to 2 groups

Treatment group

  • Glucagon: 0.05 mg/kg injected IM, 5 minutes before barium enema reduction

Control group

  • Barium enema reduction, 5 minutes after diagnosis by barium enema, similar to treatment group

Outcomes

  • Rate of successful intussusception reduction

  • Number of attempts until successful enema reduction of intussusception

  • Time until successful reduction of intussusception with enema

Notes

Procedure details: The pressure of the enema employed was kept as uniform as possible, corresponding to 100 to 120 cm of barium suspension

Reduction was considered a failure when an intussusception could no longer be moved in an oral direction after several minutes of effective pressure

5 minutes after a first attempt had failed, a second and later a third attempt was made. Failure after this point meant that the participant was prepared for operation. Participants in the control group with 3 failed attempts were administered IV glucagon, as in the treatment group, and an attempt at hydrostatic reduction was repeated. After a fourth attempt, these participants were prepared for operation

Other details: Study was undertaken in 3 steps (Step 1: initial 3 attempts at reduction as per treatment group; Step 2: participants belonging to the control group were administered glucagon and a fourth attempt was made at reduction; participants with reduction regarded as a failure were prepared for surgery; Step 3: all other participants otherwise not reduced were given a final attempt at reduction before they were prepared for surgery). We have included data only for Step 1, as this step pertains to our outcomes and criteria for inclusion

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Allocation of material to a test group and a reference group according to date of birth; participants born on an even calendar date were given an intramuscular injection of 0.05 mg glucagon/kg body weight

Allocation concealment (selection bias)

Unclear risk

Unclear who allocated participants, and who administered treatment

Incomplete outcome data (attrition bias)
All outcomes

High risk

Not stated why some participants from reference group or control group progressed to steps 2 and 3, and why others were excluded

Selective reporting (reporting bias)

Unclear risk

No protocol available. Not all expected outcomes were reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No placebo given

Treatment group given intramuscular injection; control group given no injection

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

It was not specified who assessed outcomes

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Diaz‐Aldagalan 2012

Not a randomised controlled trial

Guo 2010

Not a randomised controlled trial

Hsiao 1988

Not a randomised controlled trial

Morrison 2009

Not a randomised controlled trial

Characteristics of studies awaiting assessment [ordered by study ID]

Zhang 2014

Methods

Participants

Interventions

Outcomes

Notes

Translation pending

Characteristics of ongoing studies [ordered by study ID]

El Fiky 2016

Trial name or title

Effect of hydrocortisone on improving outcome of pneumatic reduction of infantile intussusception

Methods

  • Study design: randomised single‐blind controlled; 2‐arm study

  • Study duration: April 2015 until December 2016

Participants

  • Setting: single‐centre study

  • Location: Cairo University Pediatric Hospital

  • Health status: diagnosis of infantile intussusception

  • Number: 80

  • Age: 3 months to 4 years of age

  • Exclusion criteria: peritonitis, pneumoperitoneum, morbid patient

Interventions

Treatment group 1

  • Hydrocortisone; hydrocortisone IV 10 mg/kg with resuscitation before attempted reduction, single dose with resuscitation before attempted reduction

Treatment group 2

  • Saline; saline IV 100 mL with resuscitation before attempted reduction, single dose with resuscitation before attempted reduction

Outcomes

  • Primary outcome: success of pneumatic reduction

  • Secondary outcomes: number of trials required before successful reduction, number of complications

Starting date

April 2015

Contact information

Mahmoud El Fiky, Lecturer of Pediatric Surgery, Cairo University

Notes

ClinicalTrials.gov Identifier:NCT02691858

Mehraeen 2011

Trial name or title

The effect of midazolam in decreasing time of hydrostatic reduction of childhood intussusceptions

Methods

  • Study design: randomised single‐blind controlled; 2‐arm study

  • Study duration: not stated

Participants

  • Setting: single‐centre study

  • Location: Amirkola Children's Hospital

  • Health status: diagnosis of ileocolic intussusception

  • Number: 32

  • Age: 6 months to 4 years of age

  • Exclusion criteria: any pathological lead points, known case of chronic gastrointestinal disease, history of chronic pulmonary disease or any hypoxic disease, any signs of peritonitis or bowel perforation, such as dehydration or lethargy

Interventions

Treatment group

  • Liquid enema with midazolam (0.1 mg/kg, up to 3 mg)

Control group

  • Liquid enema with IV injection of distilled water (0.1 mg/kg, up to 3 mg)

Outcomes

  • Time of reduction

  • Successful reduction

Starting date

Date of registration: 26 August, 2011

Contact information

Dr. Raheleh Mehraeen
[email protected]

Notes

Zhang 2015

Trial name or title

Open reduction of paediatric intussusception through inferior umbilical skin fold incision

Methods

Study design: randomised single‐blind controlled; 2‐arm study

Study duration: 1 May 2014 until 30 June 2015

Participants

  • Setting: not stated

  • Location: Tongji Hospital, Wuhan, Hubei, China

  • Health status: within 48 hours of diagnosis of intussusception

  • Number (treatment group 1/treatment group 2): 60 (30/30)

  • Age: 14 years of age and younger

  • Exclusion criteria: clinical instability, severe dehydration, peritonitis, intestinal perforation, inability for air enema to show the intussusception, apex can retreat to the ascending colon or ileocaecal junction

Interventions

Treatment group 1

  • Transumbilical incision intussusception reduction

Treatment group 2

  • Laprascopic intussusception reduction

Outcomes

  • Reduction rate

  • Operation time

  • Time to first oral intake

  • Time to full feeds

  • Complications

  • Actual cost

  • Scars

Starting date

Date of registration: 26 April 2014

Contact information

Wen Zhang

[email protected]

Notes

Randomisation procedure involves flipping a coin

Data and analyses

Open in table viewer
Comparison 1. Enema plus glucagon versus enema alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Successfully reduced intussusception Show forest plot

2

218

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.94, 1.26]

Analysis 1.1

Comparison 1 Enema plus glucagon versus enema alone, Outcome 1 Successfully reduced intussusception.

Comparison 1 Enema plus glucagon versus enema alone, Outcome 1 Successfully reduced intussusception.

Open in table viewer
Comparison 2. Enema plus dexamethasone versus enema alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Successfully reduced intussusception Show forest plot

2

356

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.92, 1.10]

Analysis 2.1

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 1 Successfully reduced intussusception.

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 1 Successfully reduced intussusception.

2 Bowel perforation(s) Show forest plot

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

2.63 [0.11, 62.66]

Analysis 2.2

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 2 Bowel perforation(s).

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 2 Bowel perforation(s).

3 Recurrent intussusception Show forest plot

2

299

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.03, 0.60]

Analysis 2.3

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 3 Recurrent intussusception.

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 3 Recurrent intussusception.

4 Bowel resection Show forest plot

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.19, 4.06]

Analysis 2.4

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 4 Bowel resection.

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 4 Bowel resection.

Open in table viewer
Comparison 3. Air enema versus liquid enema

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Successfully reduced intussusception Show forest plot

2

199

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [1.10, 1.49]

Analysis 3.1

Comparison 3 Air enema versus liquid enema, Outcome 1 Successfully reduced intussusception.

Comparison 3 Air enema versus liquid enema, Outcome 1 Successfully reduced intussusception.

Study flow diagram for identification of randomised trials exploring management of intussusception in children.
Figuras y tablas -
Figure 1

Study flow diagram for identification of randomised trials exploring management of intussusception in children.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 Enema plus glucagon versus enema alone, Outcome 1 Successfully reduced intussusception.
Figuras y tablas -
Analysis 1.1

Comparison 1 Enema plus glucagon versus enema alone, Outcome 1 Successfully reduced intussusception.

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 1 Successfully reduced intussusception.
Figuras y tablas -
Analysis 2.1

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 1 Successfully reduced intussusception.

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 2 Bowel perforation(s).
Figuras y tablas -
Analysis 2.2

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 2 Bowel perforation(s).

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 3 Recurrent intussusception.
Figuras y tablas -
Analysis 2.3

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 3 Recurrent intussusception.

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 4 Bowel resection.
Figuras y tablas -
Analysis 2.4

Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 4 Bowel resection.

Comparison 3 Air enema versus liquid enema, Outcome 1 Successfully reduced intussusception.
Figuras y tablas -
Analysis 3.1

Comparison 3 Air enema versus liquid enema, Outcome 1 Successfully reduced intussusception.

Summary of findings for the main comparison. Enema plus glucagon versus enema alone

Enema plus glucagon versus enema alone summary of findings table

Patient or population: children with intussusception
Setting: single centre, in‐patient setting
Intervention: liquid enema plus glucagon
Comparison: liquid enema alone

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Risk with liquid enema alone

Risk with liquid enema plus glucagon

Successfully reduced intussusception

Study population

RR 1.09
(0.94 to 1.26)

218
(2 studies)

Lowa

739 per 1000

805 per 1000
(694 to 931)

Moderate

649 per 1000

707 per 1000
(610 to 818)

Bowel perforation(s)

Outcome not reported in any studies

Recurrent intussusception

(follow‐up: 6 months)

Outcome not reported in any studies

Bowel resection

Outcome not reported in any studies

Postoperative complication(s)

Outcome not reported in any studies

*The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to the estimate of effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aDowngraded two levels for serious concerns for high risk of selection, attrition, and performance bias

Figuras y tablas -
Summary of findings for the main comparison. Enema plus glucagon versus enema alone
Summary of findings 2. Enema plus dexamethasone versus enema alone

Enema plus dexamethasone versus enema alone summary of findings table

Patient or population: children with intussusception
Setting: single centre, in‐patient setting
Intervention: enema plus dexamethasone
Comparison: enema alone

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Risk with enema alone

Risk with enema plus dexamethasone

Successfully reduced intussusception

Study population

RR 1.01
(0.92 to 1.10)

356
(2 studies)

Lowa

157 per 1000

159 per 1000
(144 to 173)

Moderate

771 per 1000

779 per 1000
(710 to 849)

Bowel perforation(s)

Study population

RR 2.63
(0.11 to 62.66)

75
(1 study)

Lowb,c

125 per 1000

329 per 1000
(14 to 1000)

Moderate

125 per 1000

48 per 1000
(3 to 995)

Recurrent intussusception

(follow‐up: 6 months)

Study population

RR 0.14
(0.03 to 0.60)

299
(2 studies)

Lowa

69 per 1000

10 per 1000
(2 to 42)

Moderate

370 per 1000

52 per 1000
(11 to 222)

Bowel resection

Study population

RR 0.88
(0.19 to 4.06)

75
(1 study)

Lowb,c

86 per 1000

75 per 1000
(16 to 348)

Moderate

375 per 1000

330 per 1000
(71 to 1000)

Postoperative complication(s)

Outcome not reported in any studies

*The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to the estimate of effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aDowngraded two levels for serious concerns for high risk of attrition and performance bias

bDowngraded one level for serious imprecision (95% CI is wide and includes null effect)

cDowngraded one level for concerns for high risk of performance bias

Figuras y tablas -
Summary of findings 2. Enema plus dexamethasone versus enema alone
Summary of findings 3. Air enema versus liquid enema

Air enema versus liquid enema summary of findings table

Patient or population: children with intussusception
Setting: single centre, in‐hospital setting
Intervention: air enema
Comparison: liquid contrast enema

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Risk with liquid contrast enema

Risk with air enema

Successfully reduced intussusception

Study population

RR 1.28
(1.10 to 1.49)

199
(2 studies)

Lowa

677 per 1000

867 per 1000
(745 to 1000)

Moderate

712 per 1000

911 per 1000
(783 to 1000)

Bowel perforation(s)

Outcome not reported in any studies

Recurrence of intussusception

(follow‐up: 6 months)

Outcome not reported in any studies

Bowel resection

Outcome not reported in any studies

Postoperative complication(s)

Outcome not reported in any studies

*The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to the estimate of effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aDowngraded two levels for serious concerns for high risk of selection, performance, and detection bias

Figuras y tablas -
Summary of findings 3. Air enema versus liquid enema
Comparison 1. Enema plus glucagon versus enema alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Successfully reduced intussusception Show forest plot

2

218

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.94, 1.26]

Figuras y tablas -
Comparison 1. Enema plus glucagon versus enema alone
Comparison 2. Enema plus dexamethasone versus enema alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Successfully reduced intussusception Show forest plot

2

356

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.92, 1.10]

2 Bowel perforation(s) Show forest plot

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

2.63 [0.11, 62.66]

3 Recurrent intussusception Show forest plot

2

299

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.03, 0.60]

4 Bowel resection Show forest plot

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.19, 4.06]

Figuras y tablas -
Comparison 2. Enema plus dexamethasone versus enema alone
Comparison 3. Air enema versus liquid enema

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Successfully reduced intussusception Show forest plot

2

199

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [1.10, 1.49]

Figuras y tablas -
Comparison 3. Air enema versus liquid enema