The Remission Effects of First Injection of Sclerotherapy for Pediatric Rectal Prolapse: A Systematic Review and Meta-Analysis

Abstract

BackgroundPediatric rectal prolapse is a common issue in clinical practice. Among various managements, sclerotherapy is an important method to successfully treat pediatric rectal prolapse, especially for the first injection. The knowledge of the first injection of sclerotherapy can be revealed by a systemic review and meta-analysis of randomized clinical trials.MethodsWe performed a systematic search and a meta-analysis for the retrospective clinical studies of sclerotherapy in pediatric rectal prolapse. The comparison between remission and recurrence after the first injection of sclerotherapy was performed to find if the first injection of sclerotherapy can treat rectal prolapse completely. After a restricted selection, 17 studies involving 1,091 pediatric rectal prolapse subjects with sclerotherapy were enrolled in a variety of classifications of injection agents. The focused outcome was to check whether the first injection of sclerotherapy can achieve a remission status. The meta-analysis was performed by Review Manager 5.4.ResultsAmong the subjects receiving sclerotherapy, the meta-analysis favors the remission status after receiving the first injection of sclerotherapy. The meta-analysis results showed significant remission tests for the overall effect and significant heterogeneities in odds ratio and the fixed-effects model. The significant therapeutic effects remained, however, even after testing in the relative risk and the random-effects model.ConclusionsDespite significant heterogeneity and relatively low quality of evidence, the first injection of sclerotherapy may conceivably demonstrate therapeutic effects to help the patients of pediatric rectal prolapse achieve a remission status.

Rectal prolapse in the pediatric population—a narrative review of medical and surgical management

“…The difficulty in choosing the appropriate procedural management for pediatric rectal prolapse is highlighted by the over 130 surgical procedures that have been described for adults and over 40 procedures for children ( 3 , 25 , 36 , 37 ). Surgical options are utilized when patients have recurrent episodes of rectal prolapse, ulceration associated with bleeding, frequent hospital visits, reductions, prolapses, failure of medical management and/or patient or family hesitation to continue with medical management ( 38 ).…”

Expert consensus on emergency procedures for portal hypertension bleeding (2022)

“…More importantly, even in pediatric patients, injection of sclerotherapy remains an effective treatment. 58 Varicose vein suture hemostasis: Varicose vein suture hemostasis remains the most reliable hemostasis method for variceal bleeding in the lower rectum and anal canal. However, patients generally require general anesthesia or combined spinal-epidural anesthesia with a fully dilated anus before they can be implemented.…”