An analysis of children with ileocolic intussusception found no statistical link between the reduction technique used and failure once differences in disease severity were taken into account. The finding came despite a lower initial success rate for ultrasound-guided hydrostatic reduction (UGHR), at 77.7%, compared with 86.3% for fluoroscopy-guided air reduction (FGAR). The reported p-value for that initial-success comparison was 0.12.
The safety comparison was also close. Reported perforation rates were 1.3% for FGAR and 0.9% for UGHR. The authors interpret these results, together with the adjusted effectiveness analysis, as equivalent effectiveness and safety for the two techniques.
The groups did not start at the same point
That conclusion rests on a key feature of the cohort: the children who received UGHR were reported to have more severe disease at the outset. Their symptoms had lasted 34 hours, compared with 22 hours in the FGAR group. Delayed presentation beyond 48 hours was reported in 32.1% of the UGHR group and 15.0% of the FGAR group. Trapped fluid was reported in 30.4% and 16.3%, respectively. The reported p-values for those comparisons were 0.01, 0.004 and 0.02.
When one group starts with harder cases, a simple comparison can make its treatment look less effective even if the technique itself is not associated with the outcome. To address that imbalance, the researchers collected baseline clinical and ultrasound markers and used multivariable logistic regression. The model adjusted for symptom duration, an anal protruding mass, intussusceptum length and trapped fluid. It also used the area under the ROC curve, or AUC, to assess how well the model separated reductions that succeeded from those that failed.
After those severity markers were included, the adjusted odds ratio for the technique-failure association was 1.22. The 95% confidence interval ran from 0.64 to 2.28, and the reported p-value was 0.54. An adjusted odds ratio is a comparison made after accounting for the other variables in the model. Here, the result means the analysis did not find a statistical association between technique and non-operative reduction failure. It does not turn the retrospective comparison into a causal test of the two treatments.
Severity markers mattered more than the technique
The analysis instead identified several markers that were independently associated with failure. Longer symptom duration was associated with an adjusted odds ratio of 1.27 for each additional 12 hours, with a reported p-value below 0.001. An anal protruding mass was also reported as an independent statistical predictor, with an adjusted odds ratio of 3.58 and a reported p-value of 0.01.
The other markers showed a similar statistical pattern. Greater intussusceptum length, one of the measured severity markers, was associated with an adjusted odds ratio of 1.41 per centimeter, with a reported p-value below 0.001. Trapped fluid was associated with an adjusted odds ratio of 3.47, with a reported p-value below 0.001. The study described both measures as independent statistical predictors of non-operative reduction failure.
The model's AUC was 0.85, which the analysis reported as excellent discrimination. That figure summarizes how well the model separated cases by outcome in the analyzed cohort; it is not an additional success rate for either technique.
A result shaped by case mix
The authors attribute the crude differences between the groups to the more severe presentations in the UGHR group, and they recommend using severity markers to guide clinical decisions. Their conclusion is narrower than a claim that one technique causes better results: it is an interpretation of an adjusted comparison in an observational cohort.
The evidence covers 192 children aged 0 to 24 months with ileocolic intussusception treated from 2018 through 2024. That scope matters when reading the equivalence finding, because the analysis does not establish that the same adjusted result applies beyond the studied cohort. Nor does it show that the severity markers cause reduction failure.
The study reported no funding. Its data-availability statement said that no new datasets were generated or analysed during the study. The article page lists 21 August 2026 as both the publication date and the version-of-record date.
Paper data and sources
Original title: Effectiveness of ultrasound-guided hydrostatic versus fluoroscopy-guided air reduction for pediatric intussusception: a severity-adjusted cohort analysis.
Authors: Ahmed Abdelmohsen
Journal/Repository: Pediatric surgery international
Status: Peer-reviewed
First online: 2026-08-21
DOI: 10.1007/s00383-026-06585-2
Original paper · Full text