Small Bowel Obstruction—The Water-soluble Follow-through Revisited

Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction

“…Of these, six were subsequently excluded: two randomized patients to either Gastrografin ® (Schering, Berlin, Germany) or Omnipaque ™ 22, 23, one used barium as the contrast agent24, one randomized patients to either Gastrografin ® or surgery25 and two were duplicate studies26, 27. Seven studies were included in the evaluation of the diagnostic role of WSCA3–9 and nine in the assessment of its therapeutic role7, 8, 10–16. Two studies were analysed in both diagnostic and therapeutic categories7, 8 ( Fig.…”

“…Of the seven studies that examined the diagnostic role of WSCA, four were prospective observational studies3, 5, 6, 9 and three were RCTs4, 7, 8. Of the prospective observational studies, one9 scored 3 of 6 points and three3, 5, 6 scored 2 in the quality assessment.…”

“…Studies examining the diagnostic role of WSCA employed 50–100 ml Gastrografin ® 3–8 or 40 ml Urografin ® (Schering)9. Abdominal plain radiographs were obtained after 4 h3–5, 8 h9 or 24 h6–8. Patients were considered to have partial SBO if the contrast reached the colon; if not, they were considered to have complete SBO.…”

“…Seven studies with a total of 508 patients were included3–9. The presence of WSCA in the colon predicted resolution of SBO with 96 (95 per cent c.i.…”

“…For those without strangulation, however, the best way of predicting which patients can successfully undergo non‐operative management has not yet been determined. A number of studies have investigated the diagnostic role of water‐soluble contrast agent (WSCA)3–9. It has been suggested that, if oral contrast reaches the colon within 4–24 h after administration, complete obstruction is unlikely and non‐operative management is safe3, 8.…”