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IntussusceptionNCT06365333

Pneumatic Reduction For Intussusception In Children: A Retrospective Cohort Study

An observational study of Intussusception, run by National Children's Hospital, Vietnam at 2 sites in Vietnam.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

In pediatric patients, intussusception predominantly occurs in the ileocecal region, with over 90% of cases lacking identifiable causative factors, initiating through peristalsis-driven invagination of bowel segments leading to compromised blood flow and subsequent bowel edema. Read more about this study

Who is it for?
Ages 2 to 30 months
Conditions the study is for
Intussusception
What is being tested?
Fluoroscopic-guided air-enema reduction (FGAR)
Type of treatment
Surgery or procedure
How many people
3,562 participants
Where
2 sitesVietnam
Study dates
Jan 2016to Apr 2024
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 2 to 30 months
  • All sexes
  • No healthy volunteers
  • Child

Study population: Pediatric patients diagnosed with idiopathic intussusception admitted to the National Children's Hospital between January 2016 and December 2017

Who may be able to join

  • All patients diagnosed with idiopathic intussusception, admitted to the National Children's Hospital between January 2016 and December 2017, exhibiting clinical signs and symptoms consistent with intussusception, and confirmed via ultrasound examination.
  • Fluoroscopy-guided pneumatic reduction was performed with a maximum of three attempts. Patients who did not respond to pneumatic reduction underwent minimally invasive surgical intervention, either laparoscopic reduction or trans-umbilical mini-open reduction.

Who cannot join

  • Patients demonstrating clinical instability characterized by signs of peritonitis or intestinal perforation necessitating conventional laparotomy.
  • Patients deemed unsuitable for air enema reduction due to a grossly distended abdomen or compromised cardiopulmonary function.

Trial locations and contacts

2 sites in 1 country.

Vietnam2 sites
  • The National Hospital of Pediatrics

    Hanoi

  • Vinmec Research Institute of Stem Cell and Gene Technology

    Hanoi

Other trials in Vietnam

About this study

Official title: Pneumatic Reduction For Intussusception In Children: A Retrospective Cohort Study In An Ultrahigh Volume Center

In pediatric patients, intussusception predominantly occurs in the ileocecal region, with over 90% of cases lacking identifiable causative factors, initiating through peristalsis-driven invagination of bowel segments leading to compromised blood flow and subsequent bowel edema. Persistent obstruction may progress to bowel ischemia and infarction. Vietnam exhibits a higher incidence of intussusception compared to other countries, albeit with similar clinical presentations and anatomical locations, hinting at shared pathophysiology. Despite evidence supporting the safety and efficacy of non-surgical reduction techniques, many medical centers in low- to middle-income countries (LMICs) have not adopted these methods, resulting in unnecessary surgical interventions. The Vietnam National Hospital of Pediatrics (NCH) has employed air enema reduction since the early 2000s but lacks a comprehensive study on fluoroscopic-guided air-enema reduction (FGAR) techniques or success rates. Thus, this study aims to evaluate the long-term outcomes of pneumatic reduction for intussusception at NCH, a high-volume institution in a lower-middle-income country.

Read the detailed description

In pediatric patients, intussusception primarily occurs in the ileocecal region, with more than 90% of cases lacking identifiable causative factors. The invagination of bowel segments is propelled by peristalsis, leading to compromised blood flow. This venous occlusion precipitates bowel edema, and if the obstruction persists, it can progress to bowel ischemia and infarction. The incidence of intussusception in Vietnam exceeds that of any other country with available data on incidence rates. Despite variations in incidence rates, intussusception's clinical presentation and anatomical location remain largely consistent between Vietnam and other countries, suggesting a common underlying pathophysiology. Many medical centers in low- to middle-income countries (LMICs) have yet to adopt these non-surgical approaches, resulting in unnecessary surgical interventions for a significant portion of patients. At the Vietnam National Hospital of Pediatrics (NCH), air enema reduction has been a standard practice since the early 2000s. Nonetheless, there has been no comprehensive study delineating the technique of fluoroscopic-guided air-enema reduction (FGAR) at NCH, nor assessing its success rate.

Conditions
Intussusception
Being tested
Fluoroscopic-guided air-enema reduction (FGAR)
Keywords
Intussusception, Minimally invasive, Laparoscopic, Pediatric, Air enema, Pneumatic reduction
Medical subject headings
Intussusception

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Fluoroscopic-guided air-enema reduction (FGAR)Procedure or surgery

    A hand-held pump facilitated the delivery of atmospheric air, while pressure was monitored using a digital gauge. A two-way Foley's balloon catheter, ranging from 18oF to 24oF in diameter depending on age, was inserted rectally to introduce air. Following insertion, the balloon was filled with 10cc of saline to prevent air leakage, with patient immobilization ensured by leg straps and hand positioning above the head for abdominal exposure. Under intermittent fluoroscopy, the surgeon operated the pump with the right hand, inflating the catheter to 80 to 120 mmHg, simultaneously palpating the intussusceptum with the left hand, employing a deep gliding motion for deep and fixed cases. Successful reduction, indicated by air entry into the small bowel, was confirmed under fluoroscopy, with a subsequent brief rotating abdominal massage ensuring uniform air distribution throughout the small intestine, confirming complete reduction.

Study groups in NCT06365333
Study groupRoleWhat they receive
FGAR-treatedPatients diagnosed with idiopathic intussusception, admitted to the National Children's Hospital between January 2016 and December 2017, exhibiting clinical signs and symptoms consistent with intussusception, and confirmed via ultrasound examination
Receives: Procedure: Fluoroscopic-guided air-enema reduction (FGAR)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Complicated intussusception

    Complications, including bowel perforation, occurred during FGAR

    Measured: through study completion (2 years)

  2. ICU admission

    Clinically unstable patients post-FGAR that required ICU admission

    Measured: through study completion (2 years)

  3. Death

    Mortality or severe morbidity noted post-FGAR

    Measured: through study completion (2 years)

  4. Failed FGAR

    Unsuccessful reduction that requires transition to surgical intervention

    Measured: through study completion (2 years)

  5. Recurrence

    Recurrence of intussusception during the follow-up period

    Measured: through study completion (2 years)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Apr 2024
  2. Study startJan 2016
  3. Primary completionDec 2017
  4. Study completionApr 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
3,562 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06365333
Sponsor's protocol ID
1451_04/BVNTW-VNCSKTE
Status last verified
Apr 2024
First submitted
10 Apr 2024
Last updated
15 Apr 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Bines JE, Liem NT, Justice FA, Son TN, Kirkwood CD, de Campo M, Barnett P, Bishop RF, Robins-Browne R, Carlin JB; Intussusception Study Group. Risk factors for intussusception in infants in Vietnam and Australia: adenovirus implicated, but not rotavirus. J Pediatr. 2006 Oct;149(4):452-60. doi: 10.1016/j.jpeds.2006.04.010.

    PubMed 17011313
  • Tran LA, Yoshida LM, Nakagomi T, Gauchan P, Ariyoshi K, Anh DD, Nakagomi O, Thiem VD. A High Incidence of Intussusception Revealed by a Retrospective Hospital-Based Study in Nha Trang, Vietnam between 2009 and 2011. Trop Med Health. 2013 Sep;41(3):121-7. doi: 10.2149/tmh.2013-09. Epub 2013 Aug 20.

    PubMed 24155653
  • Chowdhury TK, Ahsan MQ, Chowdhury MZ, Chowdhury MTS, Imam MS, Alam MA, Farooq MAA. Hydrostatic reduction of intussusception with intermittent radiography: an alternative to fluoroscopy or ultrasound-guided reduction in low-income and middle-income countries. World J Pediatr Surg. 2021 Jan 14;4(1):e000221. doi: 10.1136/wjps-2020-000221. eCollection 2021.

    PubMed 36474637
  • Trang NV, Burnett E, Ly LH, Anh NP, Hung PH, Linh HM, Trang NCT, Canh TM, Minh VT, Tate JE, Yen C, Anh DD, Parashar UD. Recurrent intussusception among infants less than 2 years of age in Vietnam. Vaccine. 2018 Dec 14;36(51):7901-7905. doi: 10.1016/j.vaccine.2018.02.056. Epub 2018 Feb 23.

    PubMed 29478753
  • Hailemariam T, Sisay S, Mebratu Y, Belay F, Getinet T, Solomon S, Belina M, Abebe A, Hilawi Tewodros B, Manyazewal T. Effects of sedatives on radiologic enema reduction in children with ileocolic intussusception: A systematic review and meta-analysis. Eur J Radiol. 2024 Jan;170:111237. doi: 10.1016/j.ejrad.2023.111237. Epub 2023 Nov 27.

    PubMed 38039783
  • Khorana J, Tepjuk S, Singhavejsakul J, Tepmalai K, Chantakhow S, Ukarapol N, Damrongmanee A, Samerchua A, Bunchungmongkol N, Visrutaratna P, Morakote W, Nate-Anong B, Chanaturakarnnon S, Itthidecharon K, Chaimongkhon P. A comparison of the success rate of pneumatic reduction in intussusception between general anesthesia and deep sedation: a randomized controlled trial. Pediatr Surg Int. 2023 Apr 25;39(1):186. doi: 10.1007/s00383-023-05474-2.

    PubMed 37095299
  • Xie X, Wu Y, Wang Q, Zhao Y, Chen G, Xiang B. A randomized trial of pneumatic reduction versus hydrostatic reduction for intussusception in pediatric patients. J Pediatr Surg. 2018 Aug;53(8):1464-1468. doi: 10.1016/j.jpedsurg.2017.08.005. Epub 2017 Aug 8.

    PubMed 28827051
  • Beres AL, Baird R. An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for pediatric intussusception. Surgery. 2013 Aug;154(2):328-34. doi: 10.1016/j.surg.2013.04.036.

    PubMed 23889959
  • Chew R, Ditchfield M, Paul E, Goergen SK. Comparison of safety and efficacy of image-guided enema reduction techniques for paediatric intussusception: A review of the literature. J Med Imaging Radiat Oncol. 2017 Dec;61(6):711-717. doi: 10.1111/1754-9485.12601. Epub 2017 Apr 17.

    PubMed 28419712
  • Okumus M, Emektar A. Pediatric intussusception and early discharge after pneumatic reduction. Acta Chir Belg. 2019 Jun;119(3):162-165. doi: 10.1080/00015458.2018.1487190. Epub 2018 Jun 27.

    PubMed 29947299
  • Cox S, Withers A, Arnold M, Chitnis M, de Vos C, Kirsten M, le Grange SM, Loveland J, Machaea S, Maharaj A, Madhi SA, Tate JE, Parashar UD, Groome MJ. Clinical presentation and management of childhood intussusception in South Africa. Pediatr Surg Int. 2021 Oct;37(10):1361-1370. doi: 10.1007/s00383-021-04946-7. Epub 2021 Jul 2.

    PubMed 34213589
  • Wong CW, Chan IH, Chung PH, Lan LC, Lam WW, Wong KK, Tam PK. Childhood intussusception: 17-year experience at a tertiary referral centre in Hong Kong. Hong Kong Med J. 2015 Dec;21(6):518-23. doi: 10.12809/hkmj144456. Epub 2015 Sep 11.

    PubMed 26371157
  • Burnett E, Kabir F, Van Trang N, Rayamajhi A, Satter SM, Liu J, Yousafzai MT, Anh DD, Basnet AT, Flora MS, Houpt E, Qazi SH, Canh TM, Rayamajhi AK, Saha BK, Saddal NS, Muneer S, Hung PH, Islam T, Ali SA, Tate JE, Yen C, Parashar UD. Infectious Etiologies of Intussusception Among Children <2 Years Old in 4 Asian Countries. J Infect Dis. 2020 Apr 7;221(9):1499-1505. doi: 10.1093/infdis/jiz621.

    PubMed 31754717
  • Yang H, Wang G, Ding Y, Li Y, Sun B, Yue M, Wang J, Song D. Effectiveness and safety of ultrasound-guided hydrostatic reduction for children with acute intussusception. Sci Prog. 2021 Jul-Sep;104(3):368504211040911. doi: 10.1177/00368504211040911.

    PubMed 34519571
  • Wang Z, He QM, Zhang H, Zhong W, Xiao WQ, Lu LW, Yu JK, Xia HM. Intussusception patients older than 1 year tend to have early recurrence after pneumatic enema reduction. Pediatr Surg Int. 2015 Sep;31(9):855-8. doi: 10.1007/s00383-015-3726-8. Epub 2015 Jul 14.

    PubMed 26169529

Questions about this trial

What is this clinical trial studying?

An observational study of Intussusception, run by National Children's Hospital, Vietnam at 2 sites in Vietnam.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Vietnam. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Complicated intussusception (time frame: through study completion (2 years)). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06365333, which also lists 20 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Apr 2024.

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