Are Contrast Studies Reliable for Ruling Out Post-Necrotizing Enterocolitis Strictures? A Systematic Review and Meta-Analysis
In brief
Contrast studies miss about 7% of strictures after necrotizing enterocolitis
Across five studies, contrast studies had 93% sensitivity and 94% specificity for detecting strictures after necrotizing enterocolitis, but missed about 7% of cases. Only one procedure-related perforation was reported, yet these tests did not consistently guide surgical decisions. Their accuracy supports a screening role, but not use as the sole way to rule out disease.
- Journal
- Journal of pediatric surgery (Q1)
- Published
- 23 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Ester Ricci, Elisa Magrini, Mohamed Vincenti, Melissa Berardino, Federico Bianchi, Niccolò Nardi, et al.
- PMID
- 42918490
- DOI
- 10.1016/j.jpedsurg.2026.163544
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 24 October 2026): Diagnostic accuracy of contrast studies for post-NEC strictures
Abstract
BACKGROUND: Intestinal strictures are one of the common late complications of necrotizing enterocolitis (NEC). Contrast studies are among the routinely used imaging modalities for screening post-NEC strictures. This systematic review with meta-analysis aimed to determine the diagnostic accuracy of contrast studies in diagnosing post-NEC strictures. METHODS: A literature search was conducted across four electronic databases - Scopus, PubMed, ScienceDirect, and Cochrane Library - for all relevant publications published through March 2026. Contingency table data were extracted from all the studies that met the inclusion criteria. The statistical software R version 4.5.3 was used to perform the statistical analysis. RESULTS: The literature search retrieved 582 references, among which 5 were included in the review. All the studies analyzed the diagnostic accuracy of contrast studies (contrast enema (CE) or distal loopogram) in the diagnosis of post-NEC strictures. CE has high diagnostic accuracy for post-NEC stricture, with sensitivities and specificities of 93.30% and 93.57%, respectively. The false-negative rate for CE was 6.70%. There were minimal adverse events during contrast studies, with only one case of iatrogenic perforation. CONCLUSION: Contrast studies demonstrate high diagnostic accuracy; however, they may miss a clinically relevant proportion of post-NEC strictures and do not consistently influence surgical decision-making. Therefore, contrast studies may not be relied upon as a standalone tool to safely exclude disease, and their routine use must be carefully reconsidered.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.