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Meta-Analysis
. 2007 Jul 18;2007(3):CD004651.
doi: 10.1002/14651858.CD004651.pub3.

Oral water soluble contrast for the management of adhesive small bowel obstruction

S Abbas  1 , I P Bissett, B R Parry
Affiliations
Meta-Analysis

Oral water soluble contrast for the management of adhesive small bowel obstruction

S Abbas et al. Cochrane Database Syst Rev. .

Abstract

Background: Adhesions are the leading cause of small bowel obstruction. Gastrografin transit time may allow for the selection of appropriate patients for non-operative management. Some studies have shown when the contrast does not reach the colon after a designated time it indicates complete intestinal obstruction that is unlikely to resolve with conservative treatment. When the contrast does reach the large bowel, it indicates partial obstruction and patients are likely to respond to conservative treatment. Other studies have suggested that the administration of water-soluble contrast is therapeutic in resolving the obstruction.

Objectives: To determine the reliability of water-soluble contrast media and serial abdominal radiographs in predicting the success of conservative treatment in patients admitted with adhesive small bowel obstruction.Furthermore, to determine the efficacy and safety of water-soluble contrast media in reducing the need for surgical intervention and reducing hospital stay in adhesive small bowel obstruction.

Search strategy: The search was conducted using MESH terms: ''Intestinal obstruction'', ''water-soluble contrast'', "Adhesions" and "Gastrografin". The later combined with the Cochrane Collaboration highly sensitive search strategy for identifying randomised controlled trials and controlled clinical trials.

Selection criteria: 1. Prospective studies were included to evaluate the diagnostic potential of water-soluble contrast in adhesive small bowel obstruction.2. Randomised clinical trials were selected to evaluate the therapeutic role.

Data collection and analysis: 1. Studies that addressed the diagnostic role of water-soluble contrast were critically appraised and data presented as sensitivities, specificities and positive and negative likelihood ratios. Results were pooled and summary ROC curve was constructed.2. A meta-analysis of the data from therapeutic studies was performed using the Mantel -Henszel test using both the fixed effect and random effect models.

Main results: The appearance of water-soluble contrast in the colon on an abdominal X ray within 24 hours of its administration predicts resolution of an adhesive small bowel obstruction with a pooled sensitivity of 0.97, specificity of 0.96. The area under the curve of the summary ROC curve is 0.98. Six randomised studies dealing with the therapeutic role of gastrografin were included in the review, water-soluble contrast did not reduce the need for surgical intervention (OR 0.81, p = 0.3). Meta-analysis of four of the included studies showed that water-soluble contrast did reduce hospital stay compared with placebo (WMD= - 1.83) P<0.001.

Authors' conclusions: Published literature strongly supports the use of water-soluble contrast as a predictive test for non-operative resolution of adhesive small bowel obstruction. Although Gastrografin does not cause resolution of small bowel obstruction there is strong evidence that it reduces hospital stay in those not requiring surgery.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Resolution or Laparotomy, Outcome 1 Comparison of numbers of patients who had resolution of bowel obstruction without operation in both groups.
2.1
2.1. Analysis
Comparison 2 Hospital stay in days, Outcome 1 Length of hospital stay (in days) in both treatment and control group for non‐operated patients.
3.1
3.1. Analysis
Comparison 3 Strangulation, Outcome 1 Number of patients who had strangulation of small bowel in both groups.
4.1
4.1. Analysis
Comparison 4 Complications, Outcome 1 Number of patients who had complications in both treatment and control groups..
5.1
5.1. Analysis
Comparison 5 Mortality, Outcome 1 Number of patients who died in each group.
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References

References to studies included in this review

Assalia 1994 {published data only}
    1. Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M. Therapeutic effect of oral Gastrografin in adhesive, partial small‐bowel obstruction: a prospective randomised trial. Surgery 1994;115:433‐7. - PubMed
Biondo 2003 {published data only}
    1. Biondo S, Pares D, Mora L, Marti J, Kreisler E, Jaurrieta E. Randomised clinical study of Gastrografin administration in patients with adhesive small bowel obstruction. Br J Surg 2003;90:542‐6. - PubMed
Brochwicz 2003 {published data only}
    1. Brochwicz‐Lewinski MJ, Paterson‐Brown S, Murchison JT. Small bowel obstruction‐the water‐soluble follow‐through revisted. Clin Radiol 2003;58:393‐7. - PubMed
Burge 2005 {published data only}
    1. Burge J, Abbas sm, Roadly G, Donald J, Connoly A, Bissett IP, Hill AG. Randomised controlled trial of gastrogrefin in adhesive small bowel obstruction. ANZ J Surg 2005;75:672‐674. - PubMed
Chen 1998 {published data only}
    1. Chen SC, Lin FY, Lee PH, YuSC, Wang SM, Chang KJ. Water‐soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction. Br J Surg 1998;85:1692‐1694. - PubMed
Chen 1999 {published data only}
    1. Chen SC, Chang K J, Lee PH, et al. Oral urografphin in post operative small bowel obstruction. World J Surg 1999;23:1051‐4. - PubMed
Chung 1996 {published data only}
    1. Chung CC, Meng WCS, Yu SCH, Leung KL, Lau WY, Li AKC. A prospective study on the use of water‐soluble contrast follow‐through radiology in the management of small bowel obstruction. Aust NZ J Surg 1996;66:598‐601. - PubMed
Feigin 1996 {published data only}
    1. Feigin E, Seror D, Szold A, et al. Water‐soluble contrast material has no therapeutic effect on postoperative small bowel obstruction: results of a prospective, randomised clinical trial. Am J Surg 1996;171:227‐9. - PubMed
Fevang 2000 {published data only}
    1. Fevang BT, Jensen D, Fevang J, et al. Upper gastrointestinal contrast study in the management of small bowel obstruction, a prospective randomised study. Eur J Surg 2000;166:39‐43. - PubMed
Joyce 1992 {published data only}
    1. Joyce WP, Delaney PV, Gorey TF, Fitzpatrick JM. The value of water‐soluble contrast radiology in the management of acute small bowel obstruction. Ann R Coll Surg Engl 1992;74:422‐5. - PMC - PubMed
Lee 2004 {published data only}
    1. Lee JF‐Y, Meng WC‐S, Leung KL, Yu SC‐H, Poon CM, Lau WY. Water‐soluble contrast follow‐through in the management of adhesive small bowel obstruction: a prospective randomised trial. Annals of the College of Surgeons of Hong Kong 2004;8:120‐6.
Onoue 2002 {published data only}
    1. Onoue S, Katoh T, Shibata Y, Matsuo K, Suzuki M, Chigira H. The value of contrast radiology for postoperative adhesive small bowel obstruction. Hepatogastroenterology 2002;49:1576‐8. - PubMed

References to studies excluded from this review

Anderson 1997 {published data only}
    1. Anderson CA, Humphrey WT. Contrast radiography in small bowel obstruction: a prospective randomised trial. Mil Med 1997;162:749‐52. - PubMed
Blackmon 2000 {published data only}
    1. Blackmon S, Lucius C, Wilson JP, et al. The use of water‐soluble contrast in evaluating clinically equivocal small bowel obstruction.. Am Surg 2000;66:238‐42. - PubMed
Chen 1998 {published data only}
    1. Chen sc, Lin FY, Lee PH, Yu SC, Chang KJ. Water‐soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction. Br J Surg 1998;85:1692‐4. - PubMed
Choi 2002 {published data only}
    1. Choi HK, Chu KW, Law Wl. Therapeutic value of Gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomised trial. Ann surg 2002;236:1‐6. - PMC - PubMed
Dunn 1984 {published data only}
    1. Dunn JT, Halls JM, Berne TV. Roentgenographic contrast studies in acute small bowel obstruction. Arch Surg 1984;119:1305‐8. - PubMed
Enochsson 2001 {published data only}
    1. Enochsson L, Runold M, Fenyo G. Contrast radiography in small intestinal obstruction, a valuable diagnostic tool. Eur J Surg 2001;167:120‐4. - PubMed

Additional references

Cox 1993
    1. Cox MR, Gunn IF, Eastman MC, et al. The safety and duration of non‐operative treatment of adhesive small bowel obstruction.. Aust NZ J Surg 1993;63:367‐71. - PubMed
Glauser 1999
    1. Glauser T, Savioz D, Grossholz M, Lupez‐Leuchi J, Robert J, Huber O, et al. Venous intravasation of Gastrografin, a serious but underestimated complication. Eur J Surg 1999;165:274‐277. - PubMed
Jadad 1996
    1. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomised clinical trials: is blinding necessary?. Control Clin Trials 1996;17:1‐12. - PubMed
Menzies 2000
    1. Menzies D, Parker M, Hoare R, Knight A. Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissions. Ann R Coll Surg Engl 2000;180:40‐6. - PMC - PubMed
Miller 2000
    1. Miller G, Boman J, Shrier I. Gordon PH. Etiology of small bowel obstruction. Am J Surg 2000;180:33‐6. - PubMed
Moses 1993
    1. Moses LE, Shapiro D, Littenberg B. Combining independent studies of a diagnostic test into a summary ROC curve: data‐analytic approaches and some additional considerations.. Stat Med 1993;12:1293‐1316. - PubMed

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