Water-soluble contrast material has no therapeutic effect on postoperative small-bowel obstruction: Results of a prospective, randomized clinical trial

Feigin, Elad; Seror, Dan; Szold, Amir; Carmon, Moshe; Allweis, Tanir; Nissan, Aviram; Gross, Eitan; Vromen, Amos; Freund, Herbert R.

doi:10.1016/s0002-9610(97)89553-0

Cited by 87 publications

(77 citation statements)

References 10 publications

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“…Exclusion criteria were similar for all studies and included patients who had surgery within the 6 weeks before the episode of small bowel obstruction, those with signs of strangulation or peritonitis, carcinomatosis or irreducible hernia, and patients who showed signs of resolution of obstruction at the time of admission. One study excluded patients with no gas in the large bowel (complete obstruction) 15 ; this study analysed the therapeutic role of Gastrografin  .…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

“…Studies that examined the therapeutic role of Gastrografin  randomized patients to 100 ml Gastrografin  or placebo, orally or via a nasogastric tube, which was then clamped for 60 min. Patients were otherwise treated similarly 5,11,15,18,22,23 .…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

“…It was double blinded, and concealment method and dropouts were described. The other five studies were described as prospective randomized trials 5,11,15,18,23 . Each of these scored 2 on the Jadad scale 1 .…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

“…The radiography results may have influenced the decision to operate in the study of Biondo and colleagues 18 as patients who needed surgery in the Gastrografin  group underwent operation significantly earlier. Time allowed for non-operative resolution varied from 48 h 11 to 5 days 15 .…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

“…Some authors have reported that conservative treatment is indicated if contrast agent can be detected in the right colon 4-6 h after its ingestion 13,14 . Others have attempted to assess whether the administration of Gastrografin  has a therapeutic role, relieving obstruction without surgery, but the results are conflicting 4,11,15 . This review examines the role of Gastrografin  in the diagnosis and treatment of adhesive small bowel obstruction.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

Section: Quality Of Included Studiesmentioning

confidence: 99%

Section: Quality Of Included Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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γ-Guided Diagnostic Peritoneal Lavage for Detection of Bowel Perforation

et al. 2004

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Bowel perforation can be diagnosed by detection of orally administered technetium Tc 99m sulfur colloid (99m Tc SC) in diagnostic peritoneal lavage (DPL) fluid using a handheld ␥-detection probe. Design: A canine intestinal-injury model was used to test the hypothesis. The 99m Tc SC (55.5 MBq) was administered in 500 mL of saline via a nasogastric tube. A DPL with 500 mL of saline was performed at 60, 90, and 120 minutes after administration of 99m Tc SC. The radioactivity in the DPL effluent was measured using a handheld ␥ probe. A DPL effluent count that was 3 SDs above the background count was considered a positive test result. Twenty animals with perforation and 5 without perforation (negative control) were studied. Results: There were no false-positive ␥-DPL test results. Sensitivity improved by time up to 90 minutes. The lowest positive count in the DPL effluent measured by the ␥ probe corresponded to 0.2% of the administered activity. No radioactivity was detected in blood and urine samples or liver and spleen specimens. The sensitivity, specificity, accuracy, positive predictive values, and negative predictive values at 90 minutes were 95%, 100%, 96%, 100%, and 83%, respectively. Conclusions: ␥-Guided DPL is a highly sensitive and 100% specific test in the detection of small-bowel perforation. Clinical studies are warranted to determine the patient-specific factors affecting diagnostic accuracy.

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Oral water soluble contrast for the management of adhesive small bowel obstruction

Abbas

Bissett

Parry

2004

Cochrane Database of Systematic Reviews

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Water-soluble contrast material has no therapeutic effect on postoperative small-bowel obstruction: Results of a prospective, randomized clinical trial

Cited by 87 publications

References 10 publications

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

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

γ-Guided Diagnostic Peritoneal Lavage for Detection of Bowel Perforation

Oral water soluble contrast for the management of adhesive small bowel obstruction

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