The first management using intubation of a nasogastric tube with Gastrografin enterography or long tube for non-strangulated acute small bowel obstruction: a multicenter, randomized controlled trial

Katano, Takahito; Shimura, Takaya; Nishie, Hirotada; Iwai, Tomohiro; Itoh, K.; Ebi, Masahide; Mizuno, Yusuke; Togawa, Shozo; Shibata, Shunsuke; Yamada, Terumasa; Mizushima, Takashi; Inagaki, Yusuke; Kitagawa, Mika; Nojiri, Yu; Tanaka, Yoshito; Okamoto, Yasuyuki; Sugiura, Miyuki; Matoya, Sho; Nagura, Yoshihito; Inagaki, Yuki; Koguchi, Hiroki; Ono, Satoshi; Ozeki, Keiji; Hayashi, Noriyuki; Takiguchi, Shuji; Kataoka, Hiromi

doi:10.1007/s00535-020-01708-5

Cited by 14 publications

(15 citation statements)

References 18 publications

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“…The inclusion and exclusion criteria of the current RCT have been described in the original study. 5 All patients who satisfied the following inclusion criteria were prospectively enrolled in the present trial: (i) ASBO diagnosed using laboratory data (i.e., absence of shock, acidosis, or excess lactate) and abdominal computed tomography (CT) findings (i.e., absence of perforation, pneumatosis, herniation, or poor contrast of the small bowel wall and blood flow); (ii) age ≥ 20 years but ≤ 90 years; and (iii) signed informed consent form. Patients who satisfied any of the following exclusion criteria were considered ineligible to participate in this study: (1) diagnosis of free air and strangulated ileus showing pneumatosis, herniation, or poor contrast of the small bowel wall and blood flow on CT; (2) severe physical condition involving shock, severe infection, or severe dysfunction of the heart, lungs, or kidneys; (3) inability to achieve tube placement for reasons including dementia, dysphagia, and Eastern Cooperative Oncology Group performance status of four; (4) obstruction at any point between the nasal cavity and duodenum; (5) history of total gastrectomy; (6) presence of carcinomatous peritonitis; (7) hypersensitivity to iodine or iodine contrast agent; (8) pregnancy or suspicion thereof; or (9) deemed inappropriate for participation by a physician.…”

Section: Methodsmentioning

confidence: 99%

“…Study endpoints and definitions. This follow-up analysis to our previous RCT aimed to determine the long-term outcomes of NGT-G for ASBO 5 and was conducted more than a year after the final study enrollment. The cumulative surgery rates were calculated from the date of study enrollment to surgery, death due to ileus, or follow-up completion, whichever occurred first.…”

Section: Methodsmentioning

confidence: 99%

“…However, LT placement takes longer, inflicts more pain, and carries a higher risk for aspiration pneumonia compared with NGT placement. We had recently reported non-inferiority of administration of Gastrografin thorough a NGT (NGT-G) to LT as a first line treatment for ASBO when NTG-G was properly switched to the second-line LT. 5 In terms of diagnosis, previous studies have demonstrated that colonic contrast using water-soluble contrast medium (WSCM), such as Gastrografin, contributed to the decision making with regard to surgical indications, with the absence of colonic contrast 24 to 36 h following WSCM administration, suggesting the need for surgery due to the presence of severe stenosis or obstruction. 2 Although the NTG-G followed by LT strategy is a novel standard non-surgical treatment for ASBO, our previous data with regard to treatment and diagnosis had been based on short-term outcomes for only 30 days after study enrollment.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of nasogastric tube with Gastrografin for adhesive small bowel obstruction

Nishie

Shimura

Katano

et al. 2021

J of Gastro and Hepatol

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Background:We had previously reported that the administration of Gastrografin through a nasogastric tube (NGT-G) followed by long tube (LT) strategy could be a novel standard treatment for adhesive small bowel obstruction (ASBO); however, the long-term outcomes after initial improvement remain unknown. This study aimed to analyze the long-term outcomes of first-line NGT-G. Methods: Enrolled patients with ASBO were randomly assigned to receive LT or NGT-G between July 2016 and November 2018. Thereafter, the cumulative surgery rate, cumulative recurrence rate, and overall survival (OS) rate were analyzed. In addition, subset analysis was conducted to determine the cumulative recurrence rate according to colonic contrast with Gastrografin at 24 h. Results: A total of 223 patients (LT group, n = 111; NGT-G group, n = 112) were analyzed over a median follow-up duration of 550 days. The cumulative 1-year surgery rates, cumulative 1-year recurrence rates, and 1-year OS rates in the LT and NGT-G groups were 18.8% and 18.1%, 30.0% and 31.7%, and 99.1% and 96.6%, respectively; no significant differences were observed between both groups. In the NGT-G group, a negative colonic contrast at 24 h demonstrated a higher tendency for future recurrence compared with a positive colonic contrast at 24 h (1-year recurrence rate: negative contrast, 46.9% vs positive contrast, 27.6%). Conclusions: Gastrografin through a nasogastric tube followed by LT can be a promising treatment strategy for ASBO, with long-term efficacies equivalent to initial LT placement.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of nasogastric tube with Gastrografin for adhesive small bowel obstruction

Nishie

Shimura

Katano

et al. 2021

J of Gastro and Hepatol

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“…Regarding the treatment of ASBO, when computed tomography (CT) suggests strangulation, which indicates intestinal ischaemia, including decreased bowel wall enhancement, mesenteric oedema and a closed‐loop sign, emergency surgery is recommended 1–3 . Although most patients with ASBO without strangulation (non‐strangulated ASBO) respond to gastrointestinal decompression, 4 some of them fail to respond and develop persistent bowel obstruction, resulting in increased hospital length of stay (LOS). Based on CT imaging findings, we have previously reported that the faeces sign (FS) in the transitional zone (TZ) is a good prognostic marker in non‐strangulated postoperative ASBO, whereas the male sex shows a tendency to be associated with increased odds for hospital discharge (odds ratio 1.682, 95% confidence interval [CI] 0.972–2.911, P = 0.063) 5 .…”

Section: Introductionmentioning

confidence: 99%

Sex differences in non‐strangulated postoperative adhesive small bowel obstruction: a retrospective cohort study

Yamamoto

Miyagawa

Kitazawa

et al. 2021

ANZ Journal of Surgery

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Background Adhesive small bowel obstruction (ASBO) is one of the major causes of postoperative morbidity. Non‐surgical management is generally applied to non‐strangulated ASBO. Several factors have been reported to affect the response to non‐surgical management in patients with ASBO. However, the association between sex differences and non‐strangulated ASBO remains unclear. This study aimed to elucidate the effect of sex differences in non‐strangulated postoperative ASBO. Methods We divided 139 patients with a first episode of non‐strangulated postoperative ASBO into two groups: male group (n = 83) and female group (n = 56). Clinical features and prognosis were compared between the two groups. Results Female patients had lower proportions of oesophageal/gastric malignancies (P = 0.044) and colorectal malignancies (P = 0.030) and a higher proportion of uterine/ovarian malignancies (P < 0.001) than male patients did. More female patients required surgical management than male patients (P = 0.003) did. Hospital length of stay (LOS) was longer (P = 0.046) in the female group than in the male group. Multiple logistic regression analysis showed that the female sex was associated with an increased risk of the need for surgical management (odds ratio 5.318, P = 0.006). Cox proportional hazards regression analysis revealed that the female sex was positively associated with increased LOS (hazard ratio 0.687, P = 0.045). Conclusion Female sex was associated with failure of non‐surgical management and increased LOS in patients with non‐strangulated postoperative ASBO.

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“…Regarding the treatment of ASBO, when computed tomography (CT) suggests strangulation, which indicates intestinal ischemia, including decreased bowel wall enhancement, mesenteric edema, and a closed loop sign, emergency surgery is recommended (1)(2)(3). Although most patients with ASBO without strangulation (non-strangulated ASBO) respond to gastrointestinal decompression (4), some of them fail and develop persistent bowel obstruction, resulting in prolonged hospital length of stay (LOS). Based on CT imaging ndings, we have previously reported that the feces sign (FS) in the transitional zone (TZ) is a good prognostic marker in non-strangulated postoperative ASBO, whereas male sex shows a tendency to be associated with an increased odds for hospital discharge (odds ratio 1.682, 95% con dence interval…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Non-strangulated Postoperative Adhesive Small Bowel Obstruction: A Retrospective Cohort Study

Yamamoto

Miyagawa

Kitazawa

et al. 2021

Preprint

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Background: Adhesive small bowel obstruction (ASBO) is one of the major causes of postoperative morbidity. Conservative treatment is generally applied to non-strangulated ASBO. Several factors have been reported to affect the response to conservative treatment in patients with ASBO. However, the association between sex differences and non-strangulated ASBO remains unclear. This study aimed to elucidate the effect of sex differences in non-strangulated postoperative ASBO.Methods: We divided 192 admissions of 99 patients with non-strangulated postoperative ASBO into two groups: the male group (n = 137) and female group (n = 55). Clinical features and prognosis were compared between the two groups.Results: Female patients had significantly poorer performance status (p < 0.001) and lower proportions of esophageal/gastric malignancies (p = 0.002), colorectal malignancies (p = 0.034), and history of ASBO (p = 0.028) than male patients. More female patients failed conservative treatment (p = 0.036) than male patients. Hospital length of stay (LOS) was longer (p = 0.002) in the female group than in the male group. Multiple logistic regression analysis showed that female sex was associated with increased odds of requiring elective surgery (odds ratio 2.381, p = 0.040). The Cox proportional hazards regression model revealed that female sex was an independent predictor of hospital discharge (hazard ratio 0.651, p = 0.015).Conclusion: Female sex adversely affected the response to conservative treatment and LOS in patients with non-strangulated postoperative ASBO.

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The first management using intubation of a nasogastric tube with Gastrografin enterography or long tube for non-strangulated acute small bowel obstruction: a multicenter, randomized controlled trial

Cited by 14 publications

References 18 publications

Long‐term outcomes of nasogastric tube with Gastrografin for adhesive small bowel obstruction

Long‐term outcomes of nasogastric tube with Gastrografin for adhesive small bowel obstruction

Sex differences in non‐strangulated postoperative adhesive small bowel obstruction: a retrospective cohort study

Sex Differences in Non-strangulated Postoperative Adhesive Small Bowel Obstruction: A Retrospective Cohort Study

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