Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value

Abstract

Background: Adhesive small bowel obstructions are the most common postoperative causes of hospitalization. Several studies investigated the diagnostic and therapeutic role of water-soluble contrast agent (WSCA) in predicting the need for surgery, but there is no consensus.

Methods: A systematic review and meta-analysis was done of studies on diagnostic and therapeutic role of oral WSCA.

Results: WSCA had a sensitivity of 92% and a specificity of 93% in predicting resolution of obstruction without surgery; diagnostic accuracy increased significantly if abdominal X-rays were taken after 8 hours. The administration of oral WSCA reduced the need for surgery (odds ratio .55, P = .003), length of stay (weighted mean difference -2.18 days, P < .00001), and time to resolution (weighted mean difference -28.25 hours, P < .00001). No differences in terms of morbidity or mortality were recorded.

Conclusions: The administration of WSCA is accurate in predicting the need for surgery; the test should be taken after at least 8 hours from administration. WSCA is a proven safe and effective treatment, correlated with a significant reduction in the need for surgery and in the length of hospital stay.

Keywords: Adhesive small bowel obstruction; Conservative management; Gastrografin; Intestinal obstruction; Urografin; Water-soluble contrast agent.