Home›Pediatrics› Radiopaque markers, scintigraphy, and manometry remain the most widely used colonic motility assessment modalities
Radiopaque markers, scintigraphy, and manometry remain the most widely used colonic motility assessment modalitiesNewer imaging tools help track bowel issues in children
Frontiers in MedicinePublished September 18, 2026DOI ↗Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care
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Key Takeaway
Select colonic motility assessments based on specific clinical questions, noting that hydrocolonic ultrasonography is radiation-free.
This systematic review synthesizes evidence from 122 papers regarding colonic motility assessment modalities for paediatric patients. The review evaluates several modalities including radiopaque marker studies, scintigraphy, colonic manometry, hydrocolonic ultrasonography, cine-MRI, and wireless or electromagnetic capsule tracking systems. The scope covers their clinical uses, advantages, and limitations over a 31-year period.
Radiopaque marker studies, scintigraphy, and colonic manometry are identified as the most widely used investigation types. Hydrocolonic ultrasonography is noted as a radiation-free, cost-effective, and safely repeatable option for serial monitoring, though its results are dependent on operator skill. Emerging non-invasive tests include cine-MRI and various capsule tracking systems.
Several limitations are noted, including the invasiveness and radiation exposure associated with traditional methods, and the operator-dependent nature of ultrasonography. Furthermore, the authors note that evidence regarding colonic motility modalities in the paediatric population is limited compared to the adult population. Clinicians should consider these specific properties and the availability of each test to select the most appropriate investigation based on the specific clinical question for the child.
When a child struggles with chronic constipation or other bowel movement issues, doctors need reliable ways to see how the gut is moving. This is called colonic motility. For a long time, many of the most common tests involved radiation or were invasive, which can be difficult for young patients.
A review of 122 papers shows that while traditional methods like scintigraphy and manometry are widely used, they have clear limits. For example, some require specialized centers or expose the child to radiation. In contrast, hydrocolonic ultrasonography is a radiation-free and affordable option. It can be done safely multiple times, though the results depend heavily on the skill of the person performing the scan.
There are also emerging non-invasive options like cine-MRI and wireless capsules. While these newer tools offer different ways to monitor the gut, the review notes that there is still much less data available for children compared to adults. Doctors can use these different tools to pick the best test based on the specific needs of the child.
What this means for you:
Newer, radiation-free imaging tools offer safer ways to monitor bowel movements in children with motility issues.
Common questions
What are the risks of traditional bowel tests for kids?
Some common tests, like radiopaque marker studies and scintigraphy, involve radiation exposure. These methods can also be invasive or require a specialized center to perform. Because of these factors, doctors may look for alternatives that are safer or easier for children to tolerate during repeated checkups.
What are the benefits of hydrocolonic ultrasonography?
Hydrocolonic ultrasonography is a radiation-free and affordable option for checking how the bowel moves. Because it does not use radiation, it can be safely repeated many times. However, the results of this specific test depend on the skill and experience of the person performing the scan.
Are there any new non-invasive tests for children?
Yes, there are emerging non-invasive tests including cine-MRI, wireless capsules, and electromagnetic capsule tracking systems. While these offer new ways to monitor the gut, the review notes that there is currently less evidence available for these tools in children compared to the adult population.
Study Details
Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
IntroductionDisorders 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.MethodsThe 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.ResultsThe 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.DiscussionOver 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.ConclusionsThis 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 Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251034832, PROSPERO CRD420251034832.
