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 systemat...

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Bibliographic Details
Published in:The American journal of surgery 2016-06, Vol.211 (6), p.1114-1125
Main Authors: Ceresoli, Marco, M.D, Coccolini, Federico, M.D, Catena, Fausto, M.D., Ph.D, Montori, Giulia, M.D, Di Saverio, Salomone, M.D., Ph.D, Sartelli, Massimo, M.D, Ansaloni, Luca, M.D
Format: Article
Language:English
Subjects:
Abdomen
Abdominal surgery
Accuracy
Adhesive small bowel obstruction
Adhesives
Confidence intervals
Conservative management
Conservative Treatment - methods
Contrast Media - pharmacology
Contrast Media - therapeutic use
Diatrizoate Meglumine - therapeutic use
Digestive System Surgical Procedures - adverse effects
Female
Gastrografin
Hospital Mortality - trends
Humans
Intestinal obstruction
Intestinal Obstruction - etiology
Intestinal Obstruction - mortality
Intestinal Obstruction - therapy
Male
Meta-analysis
Prognosis
Quality
Risk Assessment
Severity of Illness Index
Studies
Surgery
Survival Analysis
Tissue Adhesions - etiology
Tissue Adhesions - therapy
Treatment Outcome
Urografin
Water-soluble contrast agent
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Summary: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.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2015.06.012