Are Contrast Studies Reliable for Ruling Out Post-Necrotizing Enterocolitis Strictures? A Systematic Review and Meta-Analysis.

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.