TY - JOUR
T1 - Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis
T2 - An evaluation of the diagnostic accuracy of the contrast enema
AU - Eeftinck Schattenkerk, Robert M.
AU - Eeftinck Schattenkerk, Laurens D.
AU - Musters, Gijsbert D.
AU - van Schuppen, Joost
AU - de jong, Justin R.
AU - Gorter, Ramon R.
AU - de Jonge, Wouter J.
AU - van Heurn, Ernest L. W.
AU - Derikx, Joep P. M.
N1 - Publisher Copyright: © 2022
PY - 2023/3
Y1 - 2023/3
N2 - Introduction: Contrast enemas are often made prior to stoma reversal in order to detect distal intestinal strictures distal of the stoma. If untreated these strictures can cause obstruction which might necessitate redo-surgery. However, the value of contrast enemas is unclear. Therefore, we aim to evaluate the contrast enema's diagnostic accuracy in detecting strictures in children with a stoma. Methods: Young children (≤3 years) treated with a stoma between 1998 and 2018 were retrospectively included. The STARD criteria were followed. Patients treated for anorectal malformations and those that died before stoma reversal were excluded. Surgical identification of strictures during reversal or redo-surgery within three months was used as gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) reflected diagnostic accuracy. Results: In 224 included children, strictures were found during reversal in 10% of which 95% in patients treated for necrotizing enterocolitis. Contrast enema was performed in 68% of all patients and detected 92% of the strictures. In the overall cohort, the sensitivity was 100%, specificity 98%, PPV 88% and NPV 100% whilst the AUC was 0.98. In patients treated for NEC, the sensitivity was 100%, specificity 97%, PPV 88% and NPV 100% whilst the AUC was 0.98. Conclusion: Strictures prior to stoma reversal seem to be mainly identified in patients treated for NEC and not in other diseases necessitating a stoma. Moreover, the contrast enema shows excellent diagnostic accuracy in detecting these strictures. For this reason we advise to only perform contrast enemas in patients treated for NEC. Level of Evidence: II
AB - Introduction: Contrast enemas are often made prior to stoma reversal in order to detect distal intestinal strictures distal of the stoma. If untreated these strictures can cause obstruction which might necessitate redo-surgery. However, the value of contrast enemas is unclear. Therefore, we aim to evaluate the contrast enema's diagnostic accuracy in detecting strictures in children with a stoma. Methods: Young children (≤3 years) treated with a stoma between 1998 and 2018 were retrospectively included. The STARD criteria were followed. Patients treated for anorectal malformations and those that died before stoma reversal were excluded. Surgical identification of strictures during reversal or redo-surgery within three months was used as gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) reflected diagnostic accuracy. Results: In 224 included children, strictures were found during reversal in 10% of which 95% in patients treated for necrotizing enterocolitis. Contrast enema was performed in 68% of all patients and detected 92% of the strictures. In the overall cohort, the sensitivity was 100%, specificity 98%, PPV 88% and NPV 100% whilst the AUC was 0.98. In patients treated for NEC, the sensitivity was 100%, specificity 97%, PPV 88% and NPV 100% whilst the AUC was 0.98. Conclusion: Strictures prior to stoma reversal seem to be mainly identified in patients treated for NEC and not in other diseases necessitating a stoma. Moreover, the contrast enema shows excellent diagnostic accuracy in detecting these strictures. For this reason we advise to only perform contrast enemas in patients treated for NEC. Level of Evidence: II
KW - Contrast enema
KW - Pediatric surgery
KW - Stoma
KW - Stricture
UR - http://www.scopus.com/inward/record.url?scp=85134822214&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jpedsurg.2022.06.013
DO - https://doi.org/10.1016/j.jpedsurg.2022.06.013
M3 - Article
C2 - 35871857
SN - 0022-3468
VL - 58
SP - 440
EP - 444
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 3
ER -