Evaluating Hyperosmolar Water-Soluble Contrast Media for Diagnosing Adhesive Small Bowel Obstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

This systematic review and meta-analysis investigates the use of water-soluble contrast media for diagnosing adhesive small bowel obstruction (ASBO) and predicting the need for surgery. While the potential therapeutic role of hyperosmolar water-soluble contrast (HWSC) is theorized, its efficacy remains uncertain. We assessed the effectiveness of HWSC administration compared to standard nonoperative management in patients with radiologically confirmed ASBO, specifically evaluating hospital length of stay (HLOS) and operative rates. The review was conducted following PRISMA guidelines and registered with PROSPERO. We searched Google Scholar, PubMed, and Web of Science until July 2024 to identify relevant studies. A total of 12 randomized controlled trials with a total of 1150 patients were included. Significant benefit was concluded from the use of hyperosmolar water-soluble contrast (e.g., Gastrografin), demonstrating a reduction in unwarranted prolonged hospitalizations (mean difference - 2.17 days, 95% CI -3.28 to -1.06; p = 0.0001) and a 38% reduction in the need for surgery (RR = 0.63, 95% CI 0.50-0.81; p = 0.0002). No other clinically meaningful differences were observed for secondary outcome measures. The application of HWSC in the management of ASBO appears to shorten HLOS and reduce surgical interventions compared to traditional nonoperative care. Further research is warranted to establish the most effective dosing and scheduling for HWSC administration.

Keywords: adhesive small bowel obstruction; hospital length of stay; hyperosmolar contrast; systematic review and meta analysis; water-soluble contrast.

Figure 1. PRISMA flowchart.

Figure 2. Forest plot of hospital length of stay and time to resolution of symptoms.

Burge et al., 2005 [10], Biondo et al., 2003 [15], Di Saverio et al., 2008 [16], Kumar et al., 2009 [17], Rahmani et al., 2013 [18], Haule et al., 2013 [19], Chhabra et al., 2017 [20], Khorshidi et al., 2019 [21], Katano et al., 2020 [22], Nishie et al., 2022 [23]

Figure 3. Forest plot of rates of operation, bowel resection, and mortality.

Feigin et al., 1996 [7], Burge et al., 2005 [10], Biondo et al., 2003 [15], Di Saverio et al., 2008 [16], Kumar et al., 2009 [17], Rahmani et al., 2013 [18], Haule et al., 2013 [19], Chhabra et al., 2017 [20], Khorshidi et al., 2019 [21], Katano et al., 2020 [22], Nishie et al., 2022 [23], Lee et al., 2004 [24]