Therapeutic effect of gastrografin and predictors of operative intervention in patients with adhesive small bowel obstruction: A randomized controlled study

Abstract

Objective: The study aimed to investigate the therapeutic effect of gastrografin for the conservative treatment of patients with adhesive small bowel obstruction (ASBO) and to identify the predictors of failure of conservative treatment in these patients. Material and Methods: A randomized controlled trial was conducted on 52 patients with the diagnosis of ASBO in 2016. 100 mL of Gastrografin and 100 mL of 0.9% saline solution were gavaged through the nasogastric tube in the case (n= 26) and control (n= 26) groups, respectively. Patients in the case group were subjected to plain abdominal X-Rays at 12, 24 and 48 hours after administration of gastrografin. Results: Fifty-two patients with a mean age of 57.6 ± 11.4 years (range 37-81), including 34 (65.4%) males were enrolled into the study. The number of patients who were successfully conservatively treated in the case group was 21 (80.8%), which was significantly higher than 13 (50%) in the control group (p= 0.04). Among these patients, mean hospital stay in the case group was 37.2 ± 5.5 hours (range 28-46), which was significantly shorter than 45.8 ± 9.2 hours (range 36-61) in the control group (p= 0.004). In multivariate analysis, more than one previous laparotomy was the only predictor of failure of conservative treatment (p< 0.001). Conclusion: Gastrografin may be associated with improvement of patients with ASBO. Lower number of previous laparotomies may be a predictor of successful conservative treatment of these patients.

The Effect of Hyperosmolar Water-Soluble Contrast for the Management of Adhesive Small Bowel Obstruction

“…Only 1 RCT was double blinded,22 with the remainder being nonblinded. Two RCTs described concealment methods,22,23 and 5 listed study dropouts and withdrawals 17,19,21–23…”

“…Cochrane risk of bias assessment of the RCTs revealed few issues with randomization, deviation from the intended treatment and having all the outcome data available for analysis (Table 1). [17][18][19][20][21][22][23][24][25][26][27] Most of the RCTs lacked protocols specifying exactly what treatments (such as when surgery should be performed) were rendered after WSC was administered or what criteria were used to determine hospital discharge.…”

“…Two RCTs described concealment methods, 22,23 and 5 listed study dropouts and withdrawals. 17,19,[21][22][23]…”