Pneumatic versus liquid enema reduction in the management of pediatric intussusception: an updated systematic review and meta-analysis.

Introduction and importance: Intussusception is the most frequent cause of bowel obstruction in infants. Most cases are managed nonsurgically with liquid or enema reduction. Our study aims to evaluate the efficacy and safety of air versus liquid enema reduction for the treatment of intussusception in pediatric patients. Materials and methods: A literature search was conducted on electronic databases, and the references of all included studies were searched to identify additional relevant studies meeting our inclusion criteria. Our meta-analysis included studies that compared the use of air and liquid enemas in pediatric patients with intussusception. The primary outcomes assessed were reduction success, perforation, and recurrence rates. Secondary outcomes included hospital stay duration, reduction time, reduction pressure, and fluoroscopy time. Meta-analysis was performed using RevMan 5.4. Results: Twenty-nine studies were included in the analysis, encompassing 9281 patients. The pneumatic reduction was significantly associated with a higher success rate (risk ratio: 1.22, 95% confidence interval [CI]: {1.12, 1.34}) and a shorter reduction time (mean difference [MD]: -2.64, 95% CI: [-4.73, -0.55]). No significant difference was found between the two procedures in terms of perforation rate, recurrence rate, length of hospital stays, reduction pressure, and fluoroscopy. Subgroup analysis revealed that pneumatic reduction had higher success rates in both RCTs and cohort studies and was superior to liquid reduction before the year 2011. After 2011, both techniques had similar success rates. Pneumatic reduction also showed higher success rates in both children's and non-children's hospitals and among the general radiologists' subgroup, though pediatric radiologists achieved similar success rates with both techniques. Conclusions: Pneumatic enema reduction offers higher success and faster treatment for pediatric intussusception, with comparable safety to hydrostatic methods, supporting its use as the preferred nonsurgical approach. Further comparative studies are recommended to examine radiation dose and fluoroscopy time.