Identification of Clinical Outcome Measures for Recovery of Gastrointestinal Motility in Postoperative Ileus

Bree, Sjoerd H. W. van; Bemelman, Willem A.; Hollmann, Markus W.; Zwinderman, Aeilko H.; Matteoli, Gianluca; Temna, Shaima El; Vlug, Malaika S.; Bennink, Roelof J.; Boeckxstaens, Guy E.

doi:10.1097/sla.0b013e318293ee55

Cited by 131 publications

(112 citation statements)

References 26 publications

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“…More than half of the included studies provided a definition of POI. Many of them defined it as the inhibition of gastrointestinal motility after surgery [16,22,23]. Other studies used clinical signs to characterize POI [2,19,24].…”

Section: Resultsmentioning

confidence: 99%

“…Substantial differences, however, were found in diagnostic details such as timing and clinical endpoints (table 2). Radiological examinations were mainly used for differential diagnosis [13,14,17,19,21,22,23,25], and bowel motility examinations were only used for investigational purpose in the included studies [2,16]. …”

Section: Resultsmentioning

confidence: 99%

“…However, these manifestations are also common in postoperative small-bowel obstruction, and may be seen in major surgical complications such as internal herniation, adhesions, anastomotic leakage, or intraperitoneal bleeding [13,14,15,16,17,18]. Many of these complications require immediate intervention; otherwise they may cause direct morbidity and mortality [19].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

Wu¹,

Boersema²,

Dereci³

et al. 2014

Eur Surg Res

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Background: This systematic review summarizes evidence regarding clinical endpoints, early detection, and differential diagnosis of postoperative ileus (POI). Methods: Using MEDLINE, EMBASE, Cochrane, and Web-of-Science, we identified 2,084 articles. Risk of bias and level of evidence (LOE) of the included articles were determined, and relevant results were summarized. Results: Eleven articles were included, most of which with substantial risks of bias. Bowel motility studies revealed that defecation together with solid food tolerance is the most representative clinical endpoint of POI (LOE: 2b); other clinical signs (e.g. bowel sounds, passage of flatus) did not correlate with a full recovery of bowel motility. Inflammatory parameters including interleukin (IL)-6, IL-1, and TNF-α might assist in an early detection of prolonged POI (LOE: 4). Clinical manifestations (e.g. nausea, vomiting, abdominal distension, bowel sounds, flatus) and X-ray examinations provided limited aid to the differential diagnosis of POI, while CT with Gastrografin had the best specificity and sensitivity (both 100%; LOE: 1c). Conclusions: Postoperative defecation together with tolerance of solid food intake seems to be the best clinical endpoint of POI. CT has the best differential diagnostic value between POI and other complications. Prospective studies with a high LOE are in great need. © 2014 S. Karger AG, Basel

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

Wu¹,

Boersema²,

Dereci³

et al. 2014

Eur Surg Res

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“…This is defined as the time when the following two events are met [23]: 1 tolerance to oral intake (solid or soft food) in the absence of vomiting; 2 first passage of stool.…”

Section: Discussionmentioning

confidence: 99%

“…Such heterogeneity is problematic for performing reliable comparisons between studies and translating meaningful results into clinical practice. Measurements of gastrointestinal recovery using composite outcomes such as GI-2 (time to first stool and food tolerance) or GI-3 (time to first stool and/or flatus and food tolerance) avoid arbitrary assessment criteria and may produce more meaningful outcomes [23]. In a pilot study performed in a comparable UK cohort, measurements of GI-3 provided a feasible assessment of gastrointestinal recovery, but challenges related to the measurement of flatus persisted [19]; passage of flatus can occur at night or remain unnoticed in the presence of a stoma.…”

Section: Discussionmentioning

confidence: 99%

Ileus Management International (IMAGINE): protocol for a multicentre, observational study of ileus after colorectal surgery

2018

Colorectal Disease

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Aim The management of postoperative ileus following colorectal surgery remains controversial. It is the commonest complication after elective colorectal resection and is associated with an increased incidence of postoperative adverse events. The prevention and management of postoperative ileus remains unstandardized. This study aims to describe an international profile of gastrointestinal recovery after colorectal surgery and will assess the role of non-steroidal anti-inflammatory drugs, when used as postoperative analgesia, in expediting the return of gastrointestinal function.Methods A multicentre, student-and trainee-led, prospective cohort study will be conducted across both Europe and Australasia. Adult patients undergoing elective colorectal resection during 2-week data collection periods between January and April 2018 will be included. A site-specific questionnaire will capture compliance to Enhanced Recovery after Surgery components at participating centres. The primary outcome is time to gastrointestinal recovery, measured using a composite outcome of bowel function and oral tolerance. The impact of non-steroidal anti-inflammatory drugs on gastrointestinal recovery will be evaluated along with safety data with respect to anastomotic leak, acute kidney injury and complications within 30 days of surgery.Discussion This protocol describes the methodology of an international, observational assessment of gastrointestinal recovery after colorectal surgery. It discusses key challenges and describes how the results will impact on future investigation. The study will be conducted across a large student-and trainee-led collaborative network, with prospective quality assurance and data validation strategies.

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Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery

Guay

Nishimori

Kopp

2016

Cochrane Database of Systematic Reviews

123

111

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Identification of Clinical Outcome Measures for Recovery of Gastrointestinal Motility in Postoperative Ileus

Abstract: Our data indicate that the time to SF + D best reflects recovery of gastrointestinal transit and therefore should be considered as primary outcome measure in future clinical trials on postoperative ileus.(Netherlands National Trial Register, number NTR1884 and NTR222).

Cited by 131 publications

References 26 publications

Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

Ileus Management International (IMAGINE): protocol for a multicentre, observational study of ileus after colorectal surgery

Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery

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