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Background <p>Intussusception, a serious condition where the intestine folds in on itself, is a leading cause of bowel obstructions in children. The global standard of care has shifted towards non-surgical procedures as a first response. However, evidence supporting the effectiveness and safety of this approach specifically within Sub-Saharan Africa has been scarce and disjointed. Our research systematically gathered and analyzed the existing data from the region to provide a clearer assessment.</p> Methods <p>We searched PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar from inception (earliest date covered by each database) to March 2025 for studies reporting outcomes of non-operative reduction in children with intussusception in Sub-Saharan Africa. Eligible studies focused primarily on non-operative reduction with clearly reported outcomes. Data were extracted independently by two reviewers, and study quality was assessed using the Newcastle-Ottawa Scale. Meta-analyses were performed using random-effects models for sex distribution and treatment outcomes, while complications, recurrence, and mortality were synthesized narratively. Certainty of evidence was evaluated using the GRADE framework.</p> Results <p>Nine studies including 536 patients met the inclusion criteria. The pooled male prevalence was 67% (95%CI 60–74%), and the mean age ranged from 2.8 months to 21&#xa0;months. The overall success rate of non-operative reduction was 78% (95%CI 71–86%; <i>I</i><sup>2</sup> = 78.6%), while the failure rate was 22%. Success rates were higher in studies published after 2022 (≥81.6%) compared to earlier reports (≤73.1%). The pooled perforation rate was 3% (95%CI 0–6%), with a single procedure-related mortality reported. Recurrence occurred in 7% (95%CI 3–12%) of patients. Delayed presentation, pathological lead points, and absent Doppler flow were consistent predictors of failure. Certainty of evidence was moderate for sex prevalence, low for success/failure, and low to very low for complications, recurrence, and mortality.</p> Conclusion <p>Non-operative reduction of pediatric intussusception in Sub-Saharan Africa is effective and safe, with outcomes improving in recent years, particularly with ultrasound guidance. Delayed presentation remains the major barrier to success. Expanding access to imaging, strengthening referral systems, and standardizing reporting are essential to improve outcomes and evidence quality in the region.</p>

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Efficacy and safety of nonoperative management for pediatric intussusception in Sub-Saharan Africa: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年11月22日

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  • Yohannis Derbew Molla,
  • Kidist Hunegn Setargew,
  • Hirut Tesfahun Alemu

摘要

Background

Intussusception, a serious condition where the intestine folds in on itself, is a leading cause of bowel obstructions in children. The global standard of care has shifted towards non-surgical procedures as a first response. However, evidence supporting the effectiveness and safety of this approach specifically within Sub-Saharan Africa has been scarce and disjointed. Our research systematically gathered and analyzed the existing data from the region to provide a clearer assessment.

Methods

We searched PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar from inception (earliest date covered by each database) to March 2025 for studies reporting outcomes of non-operative reduction in children with intussusception in Sub-Saharan Africa. Eligible studies focused primarily on non-operative reduction with clearly reported outcomes. Data were extracted independently by two reviewers, and study quality was assessed using the Newcastle-Ottawa Scale. Meta-analyses were performed using random-effects models for sex distribution and treatment outcomes, while complications, recurrence, and mortality were synthesized narratively. Certainty of evidence was evaluated using the GRADE framework.

Results

Nine studies including 536 patients met the inclusion criteria. The pooled male prevalence was 67% (95%CI 60–74%), and the mean age ranged from 2.8 months to 21 months. The overall success rate of non-operative reduction was 78% (95%CI 71–86%; I2 = 78.6%), while the failure rate was 22%. Success rates were higher in studies published after 2022 (≥81.6%) compared to earlier reports (≤73.1%). The pooled perforation rate was 3% (95%CI 0–6%), with a single procedure-related mortality reported. Recurrence occurred in 7% (95%CI 3–12%) of patients. Delayed presentation, pathological lead points, and absent Doppler flow were consistent predictors of failure. Certainty of evidence was moderate for sex prevalence, low for success/failure, and low to very low for complications, recurrence, and mortality.

Conclusion

Non-operative reduction of pediatric intussusception in Sub-Saharan Africa is effective and safe, with outcomes improving in recent years, particularly with ultrasound guidance. Delayed presentation remains the major barrier to success. Expanding access to imaging, strengthening referral systems, and standardizing reporting are essential to improve outcomes and evidence quality in the region.