Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction

Authors: Abbas, S. M.; Bissett, I. P.; Parry, B. R.

Source: British Journal of Surgery, Volume 94, Number 4, April 2007 , pp. 404-411(8)

Publisher: John Wiley & Sons, Ltd.

Abstract:

Background:

Adhesions are the leading cause of small bowel obstruction. Identification of patients who require surgery is difficult. This review analyses the role of Gastrografin^® as a diagnostic and therapeutic agent in the management of adhesive small bowel obstruction.

Methods:

A systematic search of Medline, Embase and Cochrane databases was performed to identify studies of the use of Gastrografin^® in adhesive small bowel obstruction. Studies that addressed the diagnostic role of water-soluble contrast agent were appraised, and data presented as sensitivity, specificity, and positive and negative likelihood ratios. Results were pooled and a summary receiver-operator characteristic (ROC) curve was constructed. A meta-analysis of the data from six therapeutic studies was performed using the Mantel-Haenszel test and both fixed- and random-effect models.

Results:

The appearance of water-soluble contrast agent in the colon on an abdominal radiograph within 24 h of its administration predicted resolution of obstruction with a pooled sensitivity of 97 per cent and specificity of 96 per cent. The area under the summary ROC curve was 0·98. Water-soluble contrast agent did not reduce the need for surgical intervention (odds ratio 0·81, P = 0·300), but it did reduce the length of hospital stay for patients who did not require surgery compared with placebo (weighted mean difference − 1·84 days; P < 0·001).

Conclusion:

Published data strongly support the use of water-soluble contrast medium as a predictive test for non-operative resolution of adhesive small bowel obstruction. Although Gastrografin^® does not reduce the need for operation, it appears to shorten the hospital stay for those who do not require surgery. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Document Type: Miscellaneous

DOI: http://dx.doi.org/10.1002/bjs.5775

Publication date: 2007-04-01

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