Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis | Inclusion criteria: Children ≤ 3 years old with stomas | Exclusion criteria: Anorectal Malformation | Died prior to reversal | Retrospective 1998 - 2018 | RESULTS | 224 patients | 10% had strictures | 95% had NEC | Conclusion: Contrast enema is a great tool for identifying strictures, but is only recommended in patients with history of NEC due to the frequency of strictures in this pathology | Contrast enema was done in 68% of the patients and detected 92% of the strictures | Overall accuracy of contrast enema: Sensitivity 100% | Specificity 98% | PPV 88% | NPV 100% | https://doi.org/10.1016/j.jpedsurg.2022.06.013 | Source: RM Eeftinck Schattenkerk et al. | Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, University of Amsterdam, Netherlands | @StayCurrentMD | @gigenace | Cincinnati Children's | Journal of Pediatric Surgery
Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis
Infographic · Apr 2023 · 1 min read
In brief
In brief
This retrospective study of 224 children found that intestinal strictures prior to stoma reversal occur almost exclusively in necrotizing enterocolitis patients (95% of cases). Contrast enema demonstrated excellent diagnostic accuracy (98% AUC) in detecting strictures in NEC patients, leading authors to recommend limiting routine pre-reversal contrast enemas to this population only.
- Intestinal strictures before stoma reversal occur in 10% of cases, with 95% found in necrotizing enterocolitis (NEC) patients.
- Contrast enema shows excellent diagnostic accuracy for stricture detection: 100% sensitivity, 98% specificity in NEC patients.
- Routine contrast enema can be safely omitted in non-NEC stoma patients, reducing unnecessary procedures and radiation exposure.
- Undetected strictures risk post-reversal obstruction requiring reoperation; contrast enema prevents this in high-risk NEC population.
- Study of 224 pediatric patients supports selective imaging protocol: contrast enema only for NEC, not other stoma indications.
Written by the GCMD Library team from the infographic.
The infographic uses a teal header, dark teal sidebar, and yellow conclusion box layout. A calendar icon represents the retrospective study period, and a simplified colon illustration appears near diagnostic accuracy metrics. The design flows from inclusion criteria through results to clinical conclusion, with arrows connecting key statistics.
Infographic by Dr. Cecilia Gigena
"Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema"
Authors: Robert M. Eeftinck Schattenkerk, Laurens D. Eeftinck Schattenkerk, Gijsbert D. Musters, Joost van Schuppen, Justin R. de jong, Ramon R. Gorter, Wouter J. de Jonge, Ernest L.W. van Heurn, Joep PM. Derikx
Full article: https://www.jpedsurg.org/article/S0022-3468(22)00433-X/fulltext
ABSTRACT
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.