Pediatrics · Medical Literature
Ultrasound-guided hydrostatic enema reduction for intussusception in children younger than 12 months: a systematic review and meta-analysis.
Abstract
Intussusception is the most common cause of bowel obstruction in infancy and may lead to substantial morbidity. This systematic review and meta-analysis evaluated success, recurrence, and perforation rates of ultrasound-guided hydrostatic enema reduction (UGHR) in infants younger than 12 months. A systematic search was performed from database inception through January 2026. A random-effects model was applied to generate pooled estimates. Analyses, including subgroup analyses by sedation status, study design, and country income level, were conducted in R, and certainty of evidence was appraised. Twenty-two studies, including 2656 infants, met the inclusion criteria. The pooled success rate was 80%, the recurrence rate was 8%, and the perforation rate was 2%. Subgroup analysis demonstrated no significant effect of sedation status or study design on outcomes, whereas income level was significantly associated with perforation risk. Substantial heterogeneity was observed across outcomes. Overall certainty of evidence was low. UGHR demonstrates a clinically meaningful success rate with an acceptable safety profile in infants under 12 months, supporting its role as a safe and effective non-surgical treatment in hemodynamically stable patients. Standardized global protocols and high-quality prospective multicenter studies are needed to optimize outcomes and strengthen the evidence base.
Clinical relevance
Intussusception is the leading cause of bowel obstruction in infancy, yet high-quality evidence specifically evaluating non-surgical reduction in infants under 12 months has been lacking, leaving clinicians without age-specific guidance. This systematic review and meta-analysis of 22 studies encompassing 2,656 infants directly addresses this evidence gap by providing pooled estimates of efficacy and safety for ultrasound-guided hydrostatic enema reduction (UGHR) in this vulnerable age group. Given that this cohort carries heightened procedural risk and is often excluded or underrepresented in broader intussusception trials, these findings are immediately relevant to pediatric surgeons, pediatric emergency physicians, and radiologists managing this population.
Key findings
1. Pooled success rate of UGHR in infants <12 months was 80% (random-effects model, 22 studies, n=2,656), establishing a clinically meaningful non-surgical reduction benchmark for this age group. 2. Pooled recurrence rate following successful UGHR was 8%, indicating that a non-trivial proportion of infants will require repeat intervention after initial reduction. 3. Pooled perforation rate was 2%, representing the primary safety endpoint; this was deemed an acceptable risk profile for hemodynamically stable patients. 4. Subgroup analysis revealed that sedation status did not significantly affect success, recurrence, or perforation outcomes, suggesting UGHR efficacy is not dependent on sedation protocols. 5. Study design (prospective vs. retrospective) did not significantly influence pooled outcome estimates across subgroup analyses. 6. Country income level was significantly associated with perforation risk, highlighting a clinically important disparity in procedural safety across healthcare resource settings. Overall certainty of evidence was rated as low due to substantial heterogeneity observed across all outcomes.
Practice implications
UGHR should be considered a safe and effective first-line non-surgical intervention for hemodynamically stable infants under 12 months presenting with intussusception, given an 80% pooled success rate and a 2% perforation rate; patients with hemodynamic instability should be triaged directly to surgical management. Clinicians should counsel families on an 8% recurrence risk post-reduction and establish clear follow-up pathways, with a low threshold for repeat imaging if symptoms recur. Institutions should work toward standardized procedural protocols for UGHR — independent of sedation practice variation — while prioritizing enrollment in prospective multicenter studies to address the currently low certainty of evidence and to clarify outcome disparities across resource settings.