Impact of a procalcitonin-based algorithm on the management of adhesion-related small bowel obstruction.
BACKGROUND
Adhesion-related small bowel obstruction (ASBO) management is difficult if there are no signs of strangulation or peritonitis when intestinal transit has not been restored. The aim of the present study was to determine the impact of combining a procalcitonin (PCT)-based algorithm with clinical signs on the management of uncomplicated ASBO.


METHODS
We performed a pilot, retrospective, single-center "before-after" study. During the "before" period (2007 to 2012), patients with uncomplicated ASBO (n=93, the Gastrografin®group) underwent a clinical examination and a Gastrografin®index. During the "after" period (2013 to 2016), patients with uncomplicated ASBO (n=70, the algorithm group) underwent a clinical examination and were assessed with the PCT-based algorithm. The study's primary outcome was the appropriateness of ASBO management. The secondary outcomes were the need for surgery and the time to surgery, the LOS, the morbidity and mortality rates, and the recurrence rate.


RESULTS
The proportion of well-managed patients was higher in the algorithm group than in the Gastrografin®group (86% vs. 47%; P<0.001). The time to surgery (48h vs 72h; P=0.02) and the LOS (4 vs. 6days, P=0.02) were significantly lower in the algorithm group. The need for surgery was similar in both groups (31% vs. 37%, P=0.49). The morbidity (P=0.69), mortality (P=0.82) and recurrence rates (P=0.57) were similar in the two groups.


CONCLUSIONS
The use of a PCT-based algorithm is of value in the routine clinical management of ASBO; it reduces the LOS and the time to surgery without increasing the need for surgery.
Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France; INSERM U1088, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France.
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Cossé
Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France; INSERM U1088, Jules Verne University of Picardie, Amiens, France.
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Sabbagh
Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France.
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Carroni
Department of Biochemistry, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France.
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Galmiche
Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France.
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Rebibo
Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
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Regimbeau
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000378:metabolism; D002116:Calcitonin / Q000378:metabolism*; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000150:complications*
D015415:Biomarkers; D002116:Calcitonin
Adhesion-related small bowel obstruction; Procalcitonin