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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

Video Published 2023-04-26 Updated 2026-08-01

Topic Overview

A retrospective study from the Netherlands (1998-2018) examined the utility of contrast enema before stoma reversal in 244 patients under three years old. The study found that 10% developed strictures, with 95% of those occurring in patients who had necrotizing enterocolitis (NEC). Contrast enema detected 92% of strictures but was performed in only 68% of patients. The presenter concludes that routine contrast enema prior to stoma reversal appears necessary primarily in patients with a history of NEC.

Key Takeaways

  • 95% of post-stoma strictures occurred in NEC patients, suggesting targeted screening rather than universal imaging. (0:00)
  • Contrast enema detected 92% of strictures when performed, supporting its use as a screening tool in high-risk populations. (0:00)
  • Only 68% of patients received pre-reversal contrast enema, indicating inconsistent practice patterns in the study period. (0:00)
  • Routine contrast enema before stoma reversal may be unnecessary except in NEC patients based on stricture distribution. (0:00)

Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

  • Cecilia Higiene — host

Chapters

  • 0:00Contrast Enema Utility in Stoma Reversal — Presenter reviews a Dutch retrospective study on the diagnostic accuracy of contrast enema before stoma reversal, focusing on stricture detection in pediatric patients with and without necrotizing enterocolitis.

Key claims

  • 0:00The study was retrospective and conducted in the Netherlands between 1998 and 2018 — Cecilia Higiene
  • 0:00The study included patients under three years old who underwent stoma reversal — Cecilia Higiene
  • 0:00244 patients were included in the study — Cecilia Higiene
  • 0:0010% of patients developed strictures — Cecilia Higiene
  • 0:0095% of strictures occurred in patients with necrotizing enterocolitis — Cecilia Higiene
  • 0:0068% of all patients had a contrast enema prior to stoma reversal — Cecilia Higiene
  • 0:00Contrast enema was able to detect 92% of strictures — Cecilia Higiene
  • 0:00Contrast enema prior to stoma reversal appears useful primarily in patients who had necrotizing enterocolitis — Cecilia Higiene

Open questions

  • What is the optimal imaging strategy for stoma reversal in non-NEC patients given the low stricture rate?
This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Contrast Enema Before Stoma Reversal: Selective Use in NEC Patients

The essential version of this episode — what it covers, the points that matter most, and what it changes for you. Written by Kai from the episode transcript and reviewed before publishing.

For the care team · Core brief · AI-written, human-reviewed

What This Study Found

A Dutch retrospective study examined whether routine contrast enema before stoma reversal actually identifies clinically significant strictures 0:00. Among 244 children under three years old who underwent stoma reversal, 10% developed strictures 0:00 0:00 0:00. The striking finding: 95% of those strictures occurred in patients whose original indication was necrotizing enterocolitis 0:00.

Of the total cohort, 68% received contrast enema before reversal 0:00. When performed, the study detected 92% of strictures 0:00. The implication is clear: contrast enema appears most useful as a pre-reversal screen specifically in the NEC population, where stricture risk concentrates 0:00.

What This Means for Practice

For patients who received ostomies for other indications — meconium ileus, Hirschsprung disease, anorectal malformations, intestinal atresia — the stricture rate in this cohort was low enough to question routine imaging. The 92% detection rate matters only if the baseline risk justifies screening 0:00.

The study does not address what happens when you skip the enema in non-NEC patients. It tells you that strictures are rare in that group, and that when you do image everyone, you catch most of what's there. It does not tell you whether finding those strictures preoperatively changes outcomes, or whether intraoperative assessment would suffice.

What Remains Uncertain

This is observational data from a single center over two decades 0:00. Practice patterns for NEC management, stoma creation timing, and reversal criteria likely evolved during that span. The study does not stratify by NEC severity, length of defunctionalized bowel, or time to reversal — all factors that might refine risk prediction further.

The strictures missed by contrast enema were presumably identified at operation or postoperatively, but the study does not detail those cases or their outcomes 0:00.

The Practical Question

If you are reversing an ostomy in a child whose indication was NEC, this study supports obtaining a contrast enema. If the indication was something else, the yield appears low, though the study does not provide a head-to-head comparison of outcomes with and without imaging in that subgroup.

Takeaways from this story

  • 95% of strictures after stoma creation occurred in NEC patients, suggesting selective rather than universal pre-reversal imaging.
  • Contrast enema detected 92% of strictures when performed, supporting its use in the high-risk NEC population.
  • Only 10% of all patients developed strictures, with concentration in NEC cases raising questions about routine imaging in other diagnoses.

Keywords

necrotizing enterocolitis strictures contrast enema stoma reversal Cincinnati Children's Hospital

Transcript

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