Ultrasound-guided hydrostatic reduction vs. fluoroscopy-guided air reduction for pediatric acute intussusception: a multicenter, prospective cohort study from China

Introduction: Acute intussusception is a common abdominal emergency in infants. Nonsurgical treatments include ultrasound-guided hydrostatic reduction (UGHR) and fluoroscopy-guided air reduction (FGAR), but their comparative efficacy and biological impact remain unclear. This study aims to compare the efficacy, safety, and gut microbiota impact of UGHR and FGAR in pediatric intussusception. Methods: This multicenter, prospective cohort study enrolled 1624 children across 6 centers in China from October 2024 to May 2025. Clinical outcomes were compared, and fecal samples were collected before and after enema for 16S rRNA sequencing. Results: UGHR and FGAR had similar success rates (96.06 vs. 96.29%) and perforation rates (0.13 vs. 0.12%). However, UGHR had a higher recurrence rate (11.22 vs. 5.66%) and a significantly higher recurrence rate within 48 h (11.22 vs. 5.66%, P < 0.0001). Gut microbiota analysis showed transient compositional changes after both procedures, with Morganella increased after UGHR and Cyanobacteria after FGAR. These findings are exploratory and not conclusive due to short follow-up and small sample size. Conclusion: Both methods are safe and effective, but UGHR is associated with a higher short-term recurrence rate. The observed microbiota changes warrant further investigation in larger longitudinal studies.