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Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants:: A Critically Appraised Topic.
Acad Radiol. 2016 May; 23(5):559-68.AR

Abstract

RATIONALE AND OBJECTIVES

The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of upper and lower gastrointestinal (GI) tract obstruction in neonates and infants.

METHODS

A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome method comparing radiography, upper GI contrast study, and ultrasound in the detection of upper GI tract obstruction such as duodenal atresia and stenosis, jejunal and ileal atresia, and malrotation and volvulus. The same methods were used to compare radiography and contrast enema in the detection of lower GI tract obstruction such as meconium plug syndrome, meconium ileus, Hirschsprung disease, and imperforate anus. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies.

RESULTS

There were no sensitivities/specificities available for the imaging diagnosis of duodenal atresia or stenosis, jejunal or ileal atresias, meconium plug, and meconium ileus or for the use of cross-table lateral radiography for the diagnosis of rectal pouch distance from skin in imperforate anus. The retrieved sensitivity for the detection of malrotation on upper GI contrast study is 96%, and the sensitivity for the diagnosis of midgut volvulus on upper GI contrast study is 79%. The retrieved sensitivity and specificity for the detection of malrotation with volvulus on ultrasound were 89% and 92%, respectively. The retrieved sensitivity and specificity for the detection of Hirschsprung disease on contrast enema were 70% and 83%, respectively. The retrieved sensitivity of invertogram for the diagnosis of rectal pouch distance from skin in imperforate anus is 27%. The retrieved sensitivities of perineal ultrasound and colostography for the diagnosis of rectal pouch distance from skin in imperforate anus were 86% and 100%, respectively.

CONCLUSIONS

There is limited evidence for the imaging diagnosis of duodenal atresia and stenosis, jejunal and ileal atresias, meconium plug, meconium ileus, and imperforate anus, with recommended practice based mainly on low-quality evidence or expert opinion. The available evidence supports the use of upper GI contrast study for the diagnosis of malrotation and volvulus, with ultrasound as an adjunct to diagnosis. Contrast enema is useful in the investigation of suspected Hirschsprung disease, but a negative study does not outrule the condition. Colostography is the investigation of choice for the work-up of infants with complex anorectal malformations before definitive surgical repair.

Authors+Show Affiliations

Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland. Electronic address: annegcarroll@gmail.com.Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland.Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland.Department of Pediatrics, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland.Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

26857524

Citation

Carroll, A G., et al. "Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants:: a Critically Appraised Topic." Academic Radiology, vol. 23, no. 5, 2016, pp. 559-68.
Carroll AG, Kavanagh RG, Ni Leidhin C, et al. Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants:: A Critically Appraised Topic. Acad Radiol. 2016;23(5):559-68.
Carroll, A. G., Kavanagh, R. G., Ni Leidhin, C., Cullinan, N. M., Lavelle, L. P., & Malone, D. E. (2016). Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants:: A Critically Appraised Topic. Academic Radiology, 23(5), 559-68. https://doi.org/10.1016/j.acra.2015.12.014
Carroll AG, et al. Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants:: a Critically Appraised Topic. Acad Radiol. 2016;23(5):559-68. PubMed PMID: 26857524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants:: A Critically Appraised Topic. AU - Carroll,A G, AU - Kavanagh,R G, AU - Ni Leidhin,C, AU - Cullinan,N M, AU - Lavelle,L P, AU - Malone,D E, Y1 - 2016/02/05/ PY - 2015/12/09/received PY - 2015/12/09/revised PY - 2015/12/27/accepted PY - 2016/2/10/entrez PY - 2016/2/10/pubmed PY - 2016/12/15/medline KW - Evidence-based medicine KW - Hirschsprung disease KW - confidence interval KW - diagnosis KW - duodenal atresia KW - duodenal stenosis KW - ileal atresia KW - imperforate anus KW - jejunal atresia KW - large bowel obstruction KW - lower gastrointestinal tract KW - malrotation KW - meconium ileus KW - meconium plug syndrome KW - sensitivity and specificity KW - small bowel obstruction KW - upper gastrointestinal tract KW - volvulus SP - 559 EP - 68 JF - Academic radiology JO - Acad Radiol VL - 23 IS - 5 N2 - RATIONALE AND OBJECTIVES: The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of upper and lower gastrointestinal (GI) tract obstruction in neonates and infants. METHODS: A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome method comparing radiography, upper GI contrast study, and ultrasound in the detection of upper GI tract obstruction such as duodenal atresia and stenosis, jejunal and ileal atresia, and malrotation and volvulus. The same methods were used to compare radiography and contrast enema in the detection of lower GI tract obstruction such as meconium plug syndrome, meconium ileus, Hirschsprung disease, and imperforate anus. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies. RESULTS: There were no sensitivities/specificities available for the imaging diagnosis of duodenal atresia or stenosis, jejunal or ileal atresias, meconium plug, and meconium ileus or for the use of cross-table lateral radiography for the diagnosis of rectal pouch distance from skin in imperforate anus. The retrieved sensitivity for the detection of malrotation on upper GI contrast study is 96%, and the sensitivity for the diagnosis of midgut volvulus on upper GI contrast study is 79%. The retrieved sensitivity and specificity for the detection of malrotation with volvulus on ultrasound were 89% and 92%, respectively. The retrieved sensitivity and specificity for the detection of Hirschsprung disease on contrast enema were 70% and 83%, respectively. The retrieved sensitivity of invertogram for the diagnosis of rectal pouch distance from skin in imperforate anus is 27%. The retrieved sensitivities of perineal ultrasound and colostography for the diagnosis of rectal pouch distance from skin in imperforate anus were 86% and 100%, respectively. CONCLUSIONS: There is limited evidence for the imaging diagnosis of duodenal atresia and stenosis, jejunal and ileal atresias, meconium plug, meconium ileus, and imperforate anus, with recommended practice based mainly on low-quality evidence or expert opinion. The available evidence supports the use of upper GI contrast study for the diagnosis of malrotation and volvulus, with ultrasound as an adjunct to diagnosis. Contrast enema is useful in the investigation of suspected Hirschsprung disease, but a negative study does not outrule the condition. Colostography is the investigation of choice for the work-up of infants with complex anorectal malformations before definitive surgical repair. SN - 1878-4046 UR - https://www.unboundmedicine.com/medline/citation/26857524/Comparative_Effectiveness_of_Imaging_Modalities_for_the_Diagnosis_of_Intestinal_Obstruction_in_Neonates_and_Infants::_A_Critically_Appraised_Topic_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1076-6332(16)00018-0 DB - PRIME DP - Unbound Medicine ER -