Effect of water-soluble contrast in colorectal surgery: A prospective randomized trial

Chen, Jiahui; Hsieh, Chung-Bao; Chao, Pei-Chieh; Liu, Hsiao-Dung; Chen, Chung-Jueng; Liu, Yao-Chi; Yu, Jyh‐Cherng

doi:10.3748/wjg.v11.i18.2802

Cited by 17 publications

(12 citation statements)

References 18 publications

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“…There was however a trend toward increased use of opioid analgesia in the Gastrografin cohort (19.8 vs 8.8 MED; P = 0.050). 12 The role of Gastrografin in PPOI was therefore unclear, and adequately powered, randomized, and blinded prospective appraisal was thought necessary to assess its clinical utility. No significant differences were noted in the number of patients requiring postoperative PN or the median duration of administration if commenced.…”

Section: Resultsmentioning

confidence: 99%

“…The compound is highly ionized and is therefore classed as "water-soluble." 9 Literature appraising the use of OWSC media in prolonged ileus is limited, [10][11][12] but despite this there remain anecdotal accounts of its administration for this purpose. 8 It is postulated that this salutary property relates to its hypertonicity-fluid is drawn out of the gut wall into the lumen, thereby reducing edema-related gastrointestinal contractile dysfunction and promoting peristalsis.…”

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confidence: 99%

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Gastrografin in Prolonged Postoperative Ileus

Vather

Josephson

Jaung³

et al. 2015

Annals of Surgery

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Gastrografin in Prolonged Postoperative Ileus

Vather

Josephson

Jaung³

et al. 2015

Annals of Surgery

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“…The administration of full-strength Gastrografin  may lead to difficulty in interpreting the results of subsequent computed tomography because its high density may cause radiological artefacts, although this has not been a problem in the authors' experience. Severe pneumonia from aspiration of Gastrografin  is a recognized complication and it would be unwise to administer this agent to patients who do not have an empty stomach or who continue to vomit 24 ; routine gastric drainage by nasogastric tube before administration should prevent this. Intravasation of contrast medium may rarely occur if the nasogastric tube is not properly placed, which may lead to renal failure or anaphylaxis 25 .…”

Section: Discussionmentioning

confidence: 99%

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

Abbas

Bissett

Parry

2007

British Journal of Surgery

101

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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.

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“…133 However, the clinical value of gastrografin in POI is less clear, with previous studies being limited to small patient numbers, heterogeneous inclusion criteria and outcome measures and conflicting results. [134][135][136] Appropriately powered, randomised and blinded prospective appraisal is required to adequately assess the efficacy of this potential intervention in ileus.…”

Section: Mechanical Reduction Of Oedemamentioning

confidence: 99%

Postoperative ileus: mechanisms and future directions for research

Vather

O’Grady

Bissett

et al. 2014

Clin Exp Pharma Physio

137

163

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Postoperative ileus (POI) is an abnormal pattern of gastrointestinal motility characterized by nausea, vomiting, abdominal distension and/or delayed passage of flatus or stool, which may occur following surgery. Postoperative ileus slows recovery, increases the risk of developing postoperative complications and confers a significant financial load on healthcare institutions. The aim of the present review is to provide a succinct overview of the clinical features and pathophysiological mechanisms of POI, with final comment on selected directions for future research.Terminology used when describing POI is inconsistent, with little differentiation made between the obligatory period of gut dysfunction seen after surgery ('normal POI') and the more clinically and pathologically significant entity of a 'prolonged POI'. Both normal and prolonged POI represent a fundamentally similar pathophysiological phenomenon. The aetiology of POI is postulated to be multifactorial, with principal mediators being inflammatory cell activation, autonomic dysfunction (both primarily and as part of the surgical stress response), agonism at gut opioid receptors, modulation of gastrointestinal hormone activity and electrolyte derangements. A final common pathway for these effectors is impaired contractility and motility and gut wall oedema. There are many potential directions for future research. In particular, there remains scope to accurately characterize the gastrointestinal dysfunction that underscores an ileus, development of an accurate risk stratification tool will facilitate early implementation of preventive measures and clinical appraisal of novel therapeutic strategies that target individual pathways in the pathogenesis of ileus warrant further investigation.

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Effect of water-soluble contrast in colorectal surgery: A prospective randomized trial

Abstract: Gastrografin not only allowed early oral feeding but also reduced the duration of hospitalization after elective colorectal surgery.

Cited by 17 publications

References 18 publications

Gastrografin in Prolonged Postoperative Ileus

Gastrografin in Prolonged Postoperative Ileus

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

Postoperative ileus: mechanisms and future directions for research

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