Online link: https://sci-hub.do/10.1016/j.surg.2016.11.026

Randomized controlled trial

Background. This study evaluated the association between oral gastrografin administration and the need for operative intervention in patients with presumed adhesive small bowel obstruction.

Methods. Between October 2006 and August 2009, 242 patients with uncomplicated acute adhesive small bowel obstruction were included in a randomized, controlled trial (the Adhesive Small Bowel Obstruction Study, NCT00389116) and allocated to a gastrografin arm or a saline solution arm. The primary end point was the need for operative intervention within 48 hours of randomization. The secondary end points were the resection rate, the time interval between the initial computed tomography and operative intervention, the time interval between oral refeeding and discharge, risk factors for the failure of nonoperative management, in-hospital mortality, duration of stay, and recurrence or death after discharge. We performed a systematic review of the literature in order to evaluate the relationship between use of gastrografin as a diagnostic/therapeutic measure, the need for operative intervention, and the duration of stay.

Results. In the gastrografin and saline solution arms, the rate of operative intervention was 24% and 20%, respectively, the bowel resection rate was 8% and 4%, the time interval between the initial computed tomography and operative intervention, and the time interval between oral refeeding and discharge were similar in the 2 arms. Only age was identified as a potential risk factor for the failure of nonoperative management. The in-hospital mortality was 2.5%, the duration of stay was 3.8 days for patients in the gastrografin arm and 3.5 days for those in the saline solution arm (P = .19), and the recurrence rate of adhesive small bowel obstruction was 7%. These results and those of 10 published

–          This study occurred in France and it recruited patients with uncomplicated acute small bowel obstruction, meaning these patients had no signs of strangulation or peritonitis, and the CT of the abdomen was consistent with an uncomplicated acute small bowel obstruction.

–          The main object of this study was to determine if water-soluble contrast medium Gastrografin was able to decrease the need for operative intervention or the duration of hospital stay in uncomplicated acute adhesive small bowel obstruction

–          (saline= control group)  Gastrografin = intervention group)

–          This study included a total of 242 patients, 121 of them were given Gastrografin and the other 121 patients were given saline solution.

–          Patients in the Gastrografin group received 100 mL of Gastrografin and those in the saline group received 100 mL of o.9% NaCl solution.

–          Results: In the Gastrografin group, 29 patients required operative intervention withing 48 hrs of receiving Gastrografin. In the saline group, 24 patients had to receive an operative intervention.

–          Among those patients who underwent operative intervention, 10 patients in the Gastrografin group had to undergo bowel resection and 5 patients in the saline group. Resection in these patients was necessary due to bowel ischemia, becoming unstable or developed strangulation)

–          When it came to mortality rate, 6 people in total died. 3 from each group and the most common cause was septic shock and cardiac shock.

–          There was no significant difference between the two groups when it came to duration in the hospital. Average hospital stay was 3 and half days.

–          Recurrence of SBO within 10 weeks was 7% in the Gastrografin group and 7% in the saline group which showed no difference.

–          Conclusion: This study strongly suggests that Gastrografin administration is of no benefit in patients with ASBO.