Impact of Protocol Utilizing Water-Soluble Contrast for Adhesive Small Bowel Obstruction

Dombert, Luke; Hussain, Amber; Bullock, Brandon; Liu, Xujun; Faughnan, Patrick; Pigneri, Danielle; May, Addison K.; Mathews, Trey; Semenza, Kristy; Granet, Jason; Behm, Robert

doi:10.1016/j.jss.2020.09.017

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…Gastrografin was used as the WSC agent in all RCTs and observational studies other than those by Yagci (Urografin Guerbet, Princeton, NJ)31 and Dombert (MD-Gastroview) 28. The timing of WSC was inconsistent across studies.…”

Section: Resultsmentioning

confidence: 99%

“…20 Other WSC agents, including Urografin and MD-Gastroview are solutions of varying concentrations of the same compounds, demonstrating similar hyperosmotic properties. 28,31 An important limitation of the WSC treatment of aSBO body of literature is the lack of standardization of protocols between studies. Some, but not all, of the studies involved the placement of an NGT shortly after hospital admission.…”

Section: Discussionmentioning

confidence: 99%

“…Water entering the intestinal lumen may also dilute its contents to create a pressure gradient, facilitating passage beyond an obstruction 20. Other WSC agents, including Urografin and MD-Gastroview are solutions of varying concentrations of the same compounds, demonstrating similar hyperosmotic properties 28,31…”

Section: Discussionmentioning

confidence: 99%

“…Time to surgery was reported in 3 RCTs and 5 observational studies. The definitions for initial timing varied, but included timing of admission, 28 CT imaging, 17 and in the remaining studies, no clear definition was given.…”

Section: Other Outcomesmentioning

confidence: 99%

“…One of these asked a discrete research question (if WSC would decrease HLOS). 28 Two of the others asked multiple research questions and 1 investigated the effect of WSC administration on aSBO recurrence. All studies outlined complete eligibility and exclusion criteria but fell short in defining outcomes, confounders, and effect modifiers.…”

Section: Newcastle-ottawa Quality Assessment Tool For Observational R...mentioning

confidence: 99%

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The Effect of Hyperosmolar Water-Soluble Contrast for the Management of Adhesive Small Bowel Obstruction

Klingbeil

Osuna-Garcia

et al. 2022

Annals of Surgery

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Objective: To better understand the efficacy of water-soluble contrast (WSC) in the treatment of adhesive small bowel obstruction (SBO). Background: Guidelines recommend using WSC to treat adhesive SBO nonoperatively by acting as a cathartic agent. The evidence supporting this practice is mixed. Methods: A systematic review and meta-analysis of published articles describing the effect of WSC compared with control treatments was performed for the period of January 1, 1990 to November 1, 2021. Study quality was assessed using the Cochrane risk-of-bias and the Newcastle-Ottawa tools. The therapeutic effect of WSC was assessed by operative rates and hospital length of stay (HLOS) in nonsurgical patients. Results: The initial search yielded 4879 articles, of which, 28 were selected for full text review. We identified 11 eligible randomized controlled trials (RCTs) which included 817 patients and 9 observational studies of 3944 patients. HLOS in nonsurgical patients decreased by 1.95 days (95% confidence interval: 0.56-3.3) in the RCTs and could not be assessed in the observational studies. WSC did not significantly affect operative rates in the RCTs (19.8% vs. 21.4%) but did reduce rates in the observational studies (11% vs. 16%, risk ratio: 0.56, 95% confidence interval: 0.39-0.82). Conclusion: WSC studies may reduce HLOS for patients who have SBO and do not require surgery. However, the current literature is heterogenous with considerable design limitations. High-quality RCTs are needed using standardized protocols to determine the full benefit of WSC for the management of SBO.

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Section: Resultsmentioning

confidence: 99%