Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value.
BACKGROUND
Adhesive small bowel obstructions are the most common postoperative causes of hospitalization. Several studies investigated the diagnostic and therapeutic role of water-soluble contrast agent (WSCA) in predicting the need for surgery, but there is no consensus.


METHODS
A systematic review and meta-analysis was done of studies on diagnostic and therapeutic role of oral WSCA.


RESULTS
WSCA had a sensitivity of 92% and a specificity of 93% in predicting resolution of obstruction without surgery; diagnostic accuracy increased significantly if abdominal X-rays were taken after 8 hours. The administration of oral WSCA reduced the need for surgery (odds ratio .55, P = .003), length of stay (weighted mean difference -2.18 days, P < .00001), and time to resolution (weighted mean difference -28.25 hours, P < .00001). No differences in terms of morbidity or mortality were recorded.


CONCLUSIONS
The administration of WSCA is accurate in predicting the need for surgery; the test should be taken after at least 8 hours from administration. WSCA is a proven safe and effective treatment, correlated with a significant reduction in the need for surgery and in the length of hospital stay.
General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo 24127, Italy. Electronic address: marco.ceresoli89@gmail.com.
Marco
M
Ceresoli
General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo 24127, Italy.
Federico
F
Coccolini
General, Emergency and Trauma Surgery Department, Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy.
Fausto
F
Catena
General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo 24127, Italy.
Giulia
G
Montori
Emergency Surgery Department, Parma University Hospital, Parma, Italy.
Salomone
S
Di Saverio
General Surgery Department, Macerata Hospital, Macerata, Italy.
Massimo
M
Sartelli
General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo 24127, Italy.
Luca
L
Ansaloni
D000072700:Conservative Treatment / Q000379:methods*; D003287:Contrast Media / Q000494:pharmacology / Q000627:therapeutic use*; D003974:Diatrizoate Meglumine / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D000267:Tissue Adhesions / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
D003287:Contrast Media; D003974:Diatrizoate Meglumine
Adhesive small bowel obstruction; Conservative management; Gastrografin; Intestinal obstruction; Urografin; Water-soluble contrast agent