The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment and lack of blinding) and by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 included 6 studies with a total of 822 children. Two studies compared liquid enema reduction plus glucagon versus liquid enema alone, 1 study compared liquid enema plus dexamethasone versus liquid enema alone, 1 study compared air enema plus dexamethasone versus air enema alone, and 2 studies compared use of liquid enema versus air enema.No studies that exclusively evaluated surgical interventions for management of intussusception were found. Meta-analysis was not possible for most review outcomes.
Air enema versus liquid enema:Air enema was more successful than liquid enema for reducing intussusception (RR 1.28, 95% CI 1.10 to 1.49; 2 studies, n=199; NNTB 6, 95% CI 4 to 19). No studies reported on the number of children with bowel perforations or on the number of children with recurrent intussusception nor any intraoperative complications, or other adverse effects.
Enema plus dexamethasone versus enema alone:No difference was observed in the rate of successful reduction of intussusception when enema plus dexamethasone was compared with enema alone (RR 1.01, 95% CI 0.92 to 1.10; 2 studies, n=356).Use of the adjunct, dexamethasone, was beneficial in reducing intussusception recurrence with liquid or air enema (RR 0.14, 95% CI 0.03 to 0.60; 2 studies, n=299) during 6 months follow-up. This equates to a number needed to treat for an additional beneficial outcome of 13 (95% CI 8 to 37). There was no difference in the number of participants with bowel perforation(s) (RR 2.63, 95% CI 0.11 to 62.66; 1 study, n=75) and in the number of participants who underwent bowel resection, an unwanted complication (RR 0.88, 95% CI 0.19 to 4.06; 1 study, n=75).
Enema plus glucagon versus enema alone:There was no difference in the rate of successfully reduced intussusception (RR 1.09, 95% CI 0.94 to 1.26; 2 studies, n=218). No studies reported on the number of children with bowel perforation nor on the number of children with recurrent intussusception.
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