title: Long-term outcomes of gastrografin in small bowel obstruction.
abstract: BACKGROUND
  The gastrografin (GG) challenge is a diagnostic and therapeutic tool used to treat patients with small bowel obstruction (SBO); however, long-term data on SBO recurrence after the GG challenge remain limited. We hypothesized that patients treated with GG would have the same long-term recurrence as those treated before the implementation of the GG challenge protocol.
  
  
  METHODS
  Patients ≥18 years who were treated for SBO between July 2009 and December 2012 were identified. We excluded patients with contraindications to the GG challenge (i.e., signs of strangulation), patients having SBO within 6-wk of previous abdominal or pelvic surgery and patients with malignant SBO. All patients had been followed a minimum of 1 y or until death. Kaplan-Meier method and Cox regression models were used to describe the time-dependent outcomes.
  
  
  RESULTS
  A total of 202 patients were identified of whom 114 (56%) received the challenge. Mean patients age was 66 y (range, 19-99 y) with 110 being female (54%). A total of 184 patients (91%) were followed minimum of 1 year or death (18 patients lost to follow-up). Median follow-up of living patients was 3 y (range, 1-5 y). During follow-up, 50 patients (25%) experienced SBO recurrences, and 24 (12%) had exploration for SBO recurrence. The 3-year cumulative rate of SBO recurrence in patients who received the GG was 30% (95% confidence interval [CI], 21%-42%) compared to 27% (95% CI, 18%-38%) for those who did not (P = 0.4). The 3-year cumulative rate of exploration for SBO recurrence in patients who received the GG was 15% (95% CI, 8%-26%) compared to 12 % (95% CI, 6%-22%) for those who did not (P = 0.6).
  
  
  CONCLUSIONS
  The GG challenge is a clinically useful tool in treating SBO patients with comparable long-term recurrence rates compared to traditional management of SBO.
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Yaser M K
authors.initials: YM
authors.lastname: Baghdadi
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Asad J
authors.initials: AJ
authors.lastname: Choudhry
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Naeem
authors.initials: N
authors.lastname: Goussous
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Khasawneh
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Polites
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: zielinski.martin@mayo.edu.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Zielinski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000628:therapy; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000601:surgery; D007441:Intubation, Gastrointestinal; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine
keywords: Gastrografin; Outcomes; Recurrence; Small bowel obstruction