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Variations in use of “water soluble contrast challenge” for small bowel obstruction among academic radiologists: results of a national survey

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Abstract

Objective

To assess the frequency and indications for use of oral water-soluble contrast challenge as a diagnostic test for small bowel obstruction in four regions of the USA.

Materials and methods

We distributed a 9-question web-based survey to the abdominal section heads of academic radiology departments throughout the USA (N = 97). The questions pertained to use of water-soluble contrast for management of small bowel obstruction. Descriptive statistics and Fisher’s exact tests were used for data analysis.

Results

The overall response rate was 46%. Eighty percent of the responding hospitals had more than 500 beds in operation. Water-soluble contrast challenge was considered standard of care for management of non-operative small bowel obstruction in 60% of the responding radiology departments. The majority of the responding departments (41%) performed 2–8 contrast challenge studies per month on average. The most frequent indication for the study was distinguishing partial vs complete bowel obstruction. Eighty percent of the responding radiologists believed that the contrast challenge is useful for management of small bowel obstruction. Overall, there was no statistically significant difference in frequency and indication for use of water-soluble contrast challenge based on geographic location.

Conclusion

The water-soluble contrast challenge was considered standard of care for non-operative management of small bowel obstruction in majority of the academic radiology departments represented in this survey. Surgeons were referring clinicians in every case. The most common clinical indication for the study was distinguishing partial versus complete small bowel obstruction.

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References

  1. 1.

    Fevang BT, Jensen D, Svanes K, Viste A.Early operation or conservative management of patients with small bowel obstruction? Eur J Surg. 2002;168(8-9):475-81.

  2. 2.

    Helmkamp BF, Kimmel J. Conservative management of small bowel obstruction. m J Obstet Gynecol. 1985 Jul 15;152(6 Pt 1):677-9.

  3. 3.

    Di Saverio S, Catena F, Ansaloni L, Gavioli M, Valentino M, Pinna AD. Water-soluble contrast medium (gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled, clinical trial. World J Surg. 2008 Oct;32(10):2293-304.

  4. 4.

    Scotté M, Mauvais F, Bubenheim M, Cossé C, Suaud L, Savoye-Collet C, Plenier I, Péquignot A, Yzet T, Regimbeau JM. Use of water-soluble contrast medium (gastrografin) does not decrease the need for operative intervention nor the duration of hospital stay in uncomplicated acute adhesive small bowel obstruction? A multicenter, randomized, clinical trial (Adhesive Small Bowel Obstruction Study) and systematic review. Surgery. 2017 May;161(5):1315-1325.

  5. 5.

    Galardi N, Collins J, Friend K.Use of early gastrografin small bowel follow-through in small bowel obstruction management. Am Surg. 2013 Aug;79(8):794-6.Abbas S, Bissett IP, Parry BR. Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD004651.

  6. 6.

    Farid M, Fikry A, El Nakeeb A, Fouda E, Elmetwally T, Yousef M, Omar W. Clinical impacts of oral gastrografin follow-through in adhesive small bowel obstruction (SBO). J Surg Res. 2010 Aug;162(2):170-6.

  7. 7.

    Weiss A, Sood D, Greenway SE, Tomassi M. Value of gastrografin in adhesive small bowel obstruction. Langenbecks Arch Surg. 2017 Dec;402(8):1233-1239.

  8. 8.

    Bueno-Lledó J, Barber S, Vaqué J, Frasson M, Garcia-Granero E, Juan-Burgueño M. Adhesive Small Bowel Obstruction: Predictive Factors of Lack of Response in Conservative Management with Gastrografin. Dig Surg. 2016;33(1):26-32.

  9. 9.

    Trésallet C, Lebreton N, Royer B, Leyre P, Godiris-Petit G, Menegaux F. Improving the management of acute adhesive small bowel obstruction with CT-scan and water-soluble contrast medium: a prospective study. Dis Colon Rectum. 2009 Nov;52(11):1869-76.

  10. 10.

    Collom ML, Duane TM, Campbell-Furtick M, Moore BJ, Haddad NN, Zielinski MD, Ray-Zack MD, Yeh DD, Choudhry AJ, Cullinane DC, Inaba K, Escalante A, Wydo S, Turay D, Pakula A, Watras J; Deconstructing dogma: Nonoperative management of small bowel obstruction in the virgin abdomen. J Trauma Acute Care Surg. 2018 Jul;85(1):33-36.

  11. 11.

    Williams SB, Greenspon J, Young HA, Orkin BA. Small bowel obstruction: conservative vs. surgical management. Dis Colon Rectum. 2005 Jun;48(6):1140-6.

  12. 12.

    Hajibandeh S, Hajibandeh S, Panda N, Khan RMA, Bandyopadhyay SK, Dalmia S, Malik S, Huq Z, Mansour M. Operative versus non-operative management of adhesive small bowel obstruction: A systematic review and meta-analysis. Int J Surg. 2017 Sep;45:58-66.

  13. 13.

    D’Agostino R, Ali NS, Leshchinskiy S, Cherukuri AR, Tam JK. Small bowel obstruction and the gastrografin challenge. Abdom Radiol (NY). 2018 Nov;43(11):2945-2954.

  14. 14.

    https://www.aamc.org. Last accessed on 4/20/2019.

  15. 15.

    United States Census Bureau, Geography Division. “Census Regions and Divisions of the United States” (PDF). Retrieved 09/18/2018. Also available at: https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf

  16. 16.

    Assalia A, Schein M, Kopelman D, Hirshberg A, HashmonaiM. Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery. 1994;115(4):433–437.

  17. 17.

    Chen SC, Lin FY, Lee PH, Yu SC, Wang SM, Chang KJ. Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction. Br J Surg. 1998;85(12):1692–1694.

  18. 18.

    Choi HK, Chu KW, Law WL. Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg. 2002;236:1–6.

  19. 19.

    Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D. Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg. 2010;97(4):470–478.

  20. 20.

    Zielinski MD, Eiken PW, Bannon MP, et al. Small bowel obstruction—who needs an operation? A multivariate prediction model. World J Surg. 2010;34: 910–919

  21. 21.

    Zielinski MD, Bannon MP. Current management of small bowel obstruction. Adv Surg. 2011;45:1–29.

  22. 22.

    Loftus T, Moore F, VanZant E, Bala T, Brakenridge S, Croft C, Lottenberg L, Richards W, Mozingo D, Atteberry L, Mohr A, Jordan J. A protocol for the management of adhesive small bowel obstruction. J Trauma Acute Care Surg. 2015;78(1):13–19; discussion 19–21.

  23. 23.

    Gastrogrfin data sheet. Available at: https://www.medsafe.govt.nz/profs/Datasheet/g/Gastrografinoralrectalsusp.pdf. Last accessed on 3/5/2019.

  24. 24.

    Caniano DA, Beaver BL. Meconium ileus: a fifteen-year experience with forty-two neonates. Surgery 1987 Oct;102(4):699-703.

  25. 25.

    Bar-Maor JA, de Carvalho JL, Chappell J. Gastrografin treatment of intestinal obstruction due to Ascaris lumbricoides. J Pediatr Surg 1984 Apr;19(2):174176.

  26. 26.

    Stordahl A, Laerum F, Gjolberg T, Enge I. Water-soluble contrast media in radiography of small bowel obstruction: Comparison of ionic and non-inoic contrast. Media ACTA Radiol 1988; 29:53-56.

  27. 27.

    Wadani HA, Al Awad NI, Hassan KA, Zakaria HM; Abdulmohsen Al Mulhim A, Alaqeel FO. Role of water soluble contrast agents in assigning patients to a non-operative course in adhesive small bowel obstruction. Oman Med J. 2011 Nov;26(6):454-6.

  28. 28.

    Chen SC1, Chang KJ, Lee PH, Wang SM, Chen KM, Lin FY. Oral urografin in postoperative small bowel obstruction. World J Surg. 1999 Oct;23(10):1051-4.

  29. 29.

    Yagci G1, Kaymakcioglu N, Can MF, Peker Y, Cetiner S, Tufan T. Comparison of Urografin versus standard therapy in postoperative small bowel obstruction. J Invest Surg. 2005 Nov-Dec;18(6):315-20.

  30. 30.

    Skucas J. Anaphylactoid reactions with gastrointestinal contrast media. AJR Am J Roentgenol. 1997 Apr;168(4):962-4.

  31. 31.

    Trulzsch DV, Penmetsa A, Karim A, Evans DA. Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography. South Med J. 1992 Dec;85(12):1255-6.

  32. 32.

    Zielinski MD, Haddad NN, Cullinane DC, Inaba K, Yeh DD, Wydo S, Turay D, Pakula A, Duane TM, Watras J, et al. Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction. J Trauma Acute Care Surg. 2017;83:47–54.

  33. 33.

    Choi HK, Chu KW, Law WL. Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg. 2002 Jul;236(1):1-6.

  34. 34.

    Biondo S, Parés D, Mora L, Martí Ragué J, Kreisler E, Jaurrieta E.Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction. Br J Surg. 2003 May;90(5):542-6.

  35. 35.

    Abbas SM, Bissett IP, Parry BR. Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction. Br J Surg. 2007 Apr;94(4):404-11.

  36. 36.

    Andrea Fryear. What’s a good survey response rate? Available at: https://www.surveygizmo.com/resources/blog/survey-response-rates/2015), Accessed 27th Feb 2019

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Acknowledgments

The authors would like to thank Dr. Kristen Bishop and Dr. Edward Chen for their helpful suggestions in editing the survey.

Author information

Correspondence to Bahar Mansoori.

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Mansoori, B., Vasan, V., Xi, Y. et al. Variations in use of “water soluble contrast challenge” for small bowel obstruction among academic radiologists: results of a national survey. Abdom Radiol (2020). https://doi.org/10.1007/s00261-020-02436-3

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Keywords

  • Small bowel obstruction
  • Gastrografin
  • Water soluble contrast
  • Fluoroscopy
  • Academic radiologists