Reducing Unnecessary Use of Contrast Enemas in the Evaluation for Hirschsprung's Disease.

This article focuses on evaluating and reducing the use of contrast enemas (CE) in the diagnostic workup of pediatric constipation and Hirschsprung's disease (HD) at a tertiary-care institution. Despite guidelines from the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommending full-thickness rectal biopsy or anal rectal manometry as preferred diagnostic tests for HD, CEs were frequently ordered, often due to provider caution or parental requests. A quality improvement project involving an educational journal club intervention for pediatric gastroenterologists significantly decreased CE orders without reducing constipation visit volume, suggesting that targeted education can align clinical practice with guidelines and reduce unnecessary testing. The study highlights the limited diagnostic utility of CEs for HD and underscores the importance of addressing provider and family concerns to optimize care. [Extracted from the article]