NEW YORK (Reuters Health) - Children who undergo successful enema reduction for intussusception don't need to stay overnight in the hospital because the risk of recurrence within 24 to 48 hours is low, researchers said Monday.

Intussusception is a common cause of abdominal pain and intestinal blockage in children.

"Despite a growing body of literature supporting outpatient management of patients with successful enema reduction, it is still common practice to hospitalize patients for 24 to 48 hours of observation. This is based on historical recommendations founded on the concerns for recurrence and postreduction complications," Dr. Matthew Gray of the Medical College of Wisconsin in Milwaukee and colleagues note in Pediatrics online June 16.

They did a meta-analysis to estimate overall, 24-hour and 48-hour intussusception recurrence rates after enema reduction. They included 69 studies that included patients up to 18 years old with radiographically proven intussusception reduced by enema.

They report that overall recurrence rates were 11.6% for contrast enema, 6.9% for ultrasound-guided noncontrast enema, and 7.7% for fluoroscopy-guided air enema. Recurrence rates at 24 hours were 2.7%, 0.9% and 1.5% for these three methods, respectively. At 48 hours, the corresponding recurrence rates were 3.6%, 3.1% and 1.9%.

The risk of recurrence after successful enema reduction was low and independent of enema type, study location, year of study completion, and study quality, the authors note.

"Assuming a 24-hour recurrence risk of 3.9%, it would require hospitalizing 26 patients for 24 hours to identify a single recurrence," they say.

"This suggests that the vast majority of recurrences will not be identified by overnight hospitalization. In addition, recurrent intussusceptions can be safely and successfully reduced via repeat enema, and significant complications associated with enema reduction are rare. Multiple studies supporting outpatient management after successful enema reduction have demonstrated high rates of success with repeat enema reduction without delayed complications," they point out.

"Consistent with other recently published studies, our results support the development of multidisciplinary guidelines for the appropriate outpatient management of those asymptomatic patients who have had successful enema reduction," Dr. Gray and colleagues conclude.

The study had no external funding and the authors have no disclosures. Dr. Gray did not respond to request for comment by press time.

SOURCE: https://bit.ly/1l31DsC