Oral water soluble contrast for the management of adhesive small bowel obstruction
Editorial Group: Cochrane Colorectal Cancer Group
Published Online: 18 JUL 2007
Assessed as up-to-date: 5 MAR 2007
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Abbas S, Bissett IP, Parry BR. Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004651. DOI: 10.1002/14651858.CD004651.pub3.
- Publication Status: Edited (no change to conclusions)
- Published Online: 18 JUL 2007
Adhesions are the leading cause of small bowel obstruction. Gastrografin transit time may allow for the selection of appropriate patients for non-operative management. Some studies have shown when the contrast does not reach the colon after a designated time it indicates complete intestinal obstruction that is unlikely to resolve with conservative treatment. When the contrast does reach the large bowel, it indicates partial obstruction and patients are likely to respond to conservative treatment. Other studies have suggested that the administration of water-soluble contrast is therapeutic in resolving the obstruction.
To determine the reliability of water-soluble contrast media and serial abdominal radiographs in predicting the success of conservative treatment in patients admitted with adhesive small bowel obstruction.
Furthermore, to determine the efficacy and safety of water-soluble contrast media in reducing the need for surgical intervention and reducing hospital stay in adhesive small bowel obstruction.
The search was conducted using MESH terms: ''Intestinal obstruction'', ''water-soluble contrast'', "Adhesions" and "Gastrografin". The later combined with the Cochrane Collaboration highly sensitive search strategy for identifying randomised controlled trials and controlled clinical trials.
1. Prospective studies were included to evaluate the diagnostic potential of water-soluble contrast in adhesive small bowel obstruction.
2. Randomised clinical trials were selected to evaluate the therapeutic role.
Data collection and analysis
1. Studies that addressed the diagnostic role of water-soluble contrast were critically appraised and data presented as sensitivities, specificities and positive and negative likelihood ratios. Results were pooled and summary ROC curve was constructed.
2. A meta-analysis of the data from therapeutic studies was performed using the Mantel -Henszel test using both the fixed effect and random effect models.
The appearance of water-soluble contrast in the colon on an abdominal X ray within 24 hours of its administration predicts resolution of an adhesive small bowel obstruction with a pooled sensitivity of 0.97, specificity of 0.96. The area under the curve of the summary ROC curve is 0.98. Six randomised studies dealing with the therapeutic role of gastrografin were included in the review, water-soluble contrast did not reduce the need for surgical intervention (OR 0.81, p = 0.3). Meta-analysis of four of the included studies showed that water-soluble contrast did reduce hospital stay compared with placebo (WMD= - 1.83) P<0.001.
Published literature strongly supports the use of water-soluble contrast as a predictive test for non-operative resolution of adhesive small bowel obstruction. Although Gastrografin does not cause resolution of small bowel obstruction there is strong evidence that it reduces hospital stay in those not requiring surgery.
Plain language summary
This review addresses two questions. First, "Does the oral administration of water soluble contrast media followed by serial abdominal radiographs during the following 24 hours predict the need for early operation or resolution?"
Second, "Does the administration of water soluble contrast media in patients with adhesive small bowel obstruction facilitate the resolution of symptoms and shorten hospital stay?"
Six studies that addressed the first question were included. The pooled results indicated that oral gastrografin is a very accurate predictor of non operative resolution of adhesive small bowel obstruction with a sensitivity of 0.97, specificity of 0.96 and area under the ROC curve of 0.98.
Five studies addressed the second question were included, although Gastrografin does not reduce the need for surgery it does reduce hospital stay in those patients who do not require surgery.
本研究使用MESH字串進行搜尋：「小腸阻塞」、「水溶性顯影劑」、「沾黏」及「Gastrografin」。後者與Cochrane Collaboration高靈敏度搜尋策略結合，以辨認隨機對照試驗(randomised controlled trials；RCTs)及隨機臨床試驗
1. 本回顧收納前瞻性研究，以評估水溶性顯影劑診斷沾黏性小腸阻塞的潛力。 2. 選擇隨機臨床試驗，以評估治療的角色
1. 嚴格地評估提出水溶性顯影劑之診斷角色的研究，數據以敏感度、特異度、陽性及陰性相似比表示。將結果合併，並描繪出總結的ROC曲線。 2. 利用固定效果及隨機效果模型之Mantel enszel檢定，將治療研究的數據進行統合分析
透過腹部X光檢查，可以觀察到服用後24小時內，水溶性顯影劑出現在結腸中，利用這種方式預測沾黏性小腸阻塞是否緩解的合併敏感度為0.97、特異度為0.96。在總結的ROC曲線中，曲線下面積為0.98。本回顧包含6項針對gastrografin之治療角色所進行的隨機研究，水溶性顯影劑並未減少患者接受外科手術的需要(OR 0.81，p = 0.3)。4項收納的研究整合分析，顯示水溶性顯影劑與安慰劑相較之下，並不能減少病人的住院日數(WMD = – 1.83) P < 0.001
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌
這篇回顧提出二個問題。第一，「口服水溶性顯影劑後，再於之後的24小時內進行連續的腹部X光檢查，能否預測患者需要及早接受手術或緩解？」 其次，「讓沾黏性小腸阻塞的病人服用水溶性顯影劑，能否促進症狀的緩解及縮短住院日數？」 本回顧收納了6項提出第一個問題的研究。合併的結果顯示，口服gastrografin是非常準確的沾黏性小腸阻塞以非手術方式緩解之預測因子，其敏感度達0.97、特異度達0.96，且ROC曲線下的面積為0.98。 本回顧包含5項提出第二個問題的研究，雖然gastrografin並未減少患者接受手術的需要，但是它可以減少不需要手術的患者之住院日數