Early gastrografin administration after ileus tube insertion does not improve the clinical outcomes in patients with adhesive small bowel obstruction

Abstract

Background Gastrointestinal decompression through ileus tube is useful for the treatment of adhesive small bowel obstruction (ASBO). Gastrografin administration through the ileus tube is performed if decompression therapy fails to relieve obstruction. However, the appropriate timing of gastrografin administration is unclear. The present study aimed to evaluate the efficacy of gastrografin administration within 48 h after admission.Methods This retrospective study used the data of patients with ASBO admitted to our hospital between January 2014 and August 2018. The study included those who underwent ileus tube intubation but did not achieve obstruction relief for over 24 h after admission. The patients were classified into the following two groups: those treated with gastrografin administration within 48 h after admission (EGA group) and those treated without gastrografin administration within 48 h after admission (non-EGA [NEGA] group). Propensity-score matching was performed to compensate for confounding differences between the groups. The short-term outcomes of therapeutic effectiveness such as the rate of surgery avoidance, the period until the first stool, period of ileus tube intubation, and total period of hospital admission were evaluated and compared between the two groups.Results This study included 152 patients: 67 in the EGA group and 85 in the NEGA group. Fifty-five pairs were matched with similar background characteristics. After matching, the rates of surgery avoidance were 89.1% (49/55) and 94.5% (52/55) in the matched EGA and NEGA groups, respectively (P = 0.49). Although the median insertion days of ileus tube in the NEGI group were significantly lesser than those in the EGA group (7 [5–9] vs. 5 [4.5–7], P = 0.017), other therapeutic outcomes were not significantly different between the two groups. In the non-EGA group, 5.5% (3/55) achieved obstruction relief without gastrografin administration.Conclusions Early gastrografin administration might not be superior to non-early gastrografin administration in clinical outcomes of patients with ASBO. Follow-up by decompression with ileus tube for at least 48 h after admission is required in patients with ASBO, which may avoid unnecessary gastrografin administration and consequently reduce the total cost of treatment.