Thirty years of paediatric colonic motility assessment modalities: a systematic review.

Introduction: Disorders of paediatric colonic motility may arise following operative repair of congenital colorectal conditions, as well as spontaneously. This may lead to symptoms of faecal incontinence, in addition to constipation. Management of such typically requires several investigations, clinic appointments and treatment strategies. Different investigation modalities are available to objectively and accurately describe gastrointestinal transit time. In the paediatric setting, most of these investigations are invasive, involve radiation, or require patient hospital admission. This systematic review summarises paediatric colonic motility investigations by compiling an assessment of modalities available over the last 31 years, their uses, advantages, and limitations. Methods: The following databases (Cochrane, EMBASE, MEDLINE) were interrogated. The keywords used were "paediatric", "pediatric", "colonic motility", and "investigation", searched as keywords and Medical Subject Heading/Emtree subject heading. Studies that were included were case reports, prospective and retrospective cohort studies, case series, and reviews discussing and comparing modalities to investigate paediatric (< 18 years old) colonic motility. Inclusion criteria included papers published in the last 31 years, including data about paediatric colonic motility investigations indications, rationale for investigation of choice, advantages and limitations. The protocol was registered with PROSPERO (ID 1034832). Study selection was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Results: The initial search yielded 1061 papers. After removing duplicates and screening abstracts and full texts, 122 papers were included for analysis. The most widely-used motility investigation types were radiopaque marker studies, scintigraphy and colonic manometry. However, these had limitations, including radiation exposure, the need for an experienced-centre, and invasiveness. Hydrocolonic ultrasonography was radiation-free, not expensive, and safely repeatable for serial monitoring or assessment, but results were operator-dependent. Newer non-invasive tests that aim to limit radiation exposure have been emerging, such as cine-MRI, wireless capsule and the electromagnetic capsule tracking system. Assessment of anorectal function was often combined with colonic motility assessment to provide a full assessment, depending upon the clinical picture and diagnostic objectives. Discussion: Over the last 31 years numerous investigations have been utilised to study bowel anatomy, function, and neuromuscular ability. Each of these modalities have advantages, but also limitations. It is crucial to know the intrinsic characteristics of each modality to help decide which is most appropriate for the clinical indication in question. Radiopaque marker studies, scintigraphy and colonic manometry were the three most widely reported colonic motility studies methods. Evidence regarding colonic motility modalities in paediatrics was limited compared with the adult population. This lack of evidence is likely due to the invasive nature of some of these investigations, costs, radiation exposure, and limited availability at specific centres. It is crucial for clinicians involved in paediatric patient care to be familiar with available tests, their properties, availabilities, and to use the most appropriate investigation to answer each specific clinical question. Conclusions: This systematic review has shown that, to date, there are several colonic motility assessment modalities that all have their advantages, limitations and different indications. It is imperative for clinicians to base their investigative plan on the specific patient, clinical/centre expertise and clinical question. In the future, there is a need to develop a non-invasive, objective, world-wide reproducible and ambulatory method that may provide information on actual day-to-day physiological colonic motility. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251034832, PROSPERO CRD420251034832.