World Journal of Surgery

, Volume 32, Issue 10, pp 2293–2304

Water-Soluble Contrast Medium (Gastrografin) Value in Adhesive Small Intestine Obstruction (Asio): A Prospective, Randomized, Controlled, Clinical Trial

  • Salomone Di Saverio
  • Fausto Catena
  • Luca Ansaloni
  • Margherita Gavioli
  • Massimo Valentino
  • Antonio Daniele Pinna
Article

Abstract

Background

Patients with adhesive small intestine obstruction (ASIO) are difficult to evaluate and to manage and their treatment is still controversial. The diagnostic and therapeutic role of water-soluble contrast medium (Gastrografin) in ASIO is still debated. This study was designed to determine the therapeutic role of Gastrografin in patients with ASIO.

Methods

The study was a multicenter, prospective, randomized, controlled investigation. The primary end points were the evaluation of the operative rate reduction and shortening the hospital stay after the use of Gastrografin. A total of 76 patients were randomized into two groups: the control group received traditional treatment (TT), whereas the study group (GG) received in addition a Gastrografin meal and follow-through study immediately. Patients with Gastrografin in the colon within 36 hours were considered to be partially obstructed and submitted to nonoperative management. If after 36 hours, the Gastrografin had not entered the colon, the subjects were submitted to laparotomy.

Results

No significant differences were found in age, sex, intravenous administration of prokinetics, incidence and characteristics of the previous procedures in surgical history of the patients, previous episodes of ASIO and surgery for adhesiolysis, or duration of symptoms before admission. In the GG group obstruction resolved subsequently in 31 of 38 cases (81.5%) after a mean time of 6.4 hours. The remaining seven patients were submitted to surgery, and one of them needed bowel resection for strangulation. In the control group, 21 patients were not submitted to surgery (55%), whereas 17 showed persistent untreatable obstruction and required laparotomy: 2 of them underwent bowel resection for strangulation. The difference in the operative rate between the two treatment groups reached statistical significance (p = 0.013). The time from the hospital admission for obstruction to resolution of symptoms was significantly lower in the GG group (6.4 vs. 43 hours; p < 0.01). The length of hospital stay revealed a significant reduction in the GG group (4.7 vs. 7.8 days; p < 0.05). This reduction was more evident in the subset of patients who did not require surgery (3 vs. 5.1 days; < 0.01). No GG-related complications or significant differences in major complications and the relapse rate were found (relapse rate, 34.2% after a mean time to relapse of 6.3 months in the GG group vs. 42.1% after 7.6 months in the TT; p = not significant).

Conclusions

Data showed that the use of Gastrografin in ASIO is safe and reduces the operative rate and the time to resolution of obstruction, as well as the hospital stay.

References

  1. 1.
    Playforth RH, Holloway JB, Griffen WO Jr (1970) Mechanical small bowel obstruction: a plea for earlier surgical intervention. Ann Surg 171:783–788PubMedCrossRefGoogle Scholar
  2. 2.
    Seror D, Feigin E, Szold A, Allweis TM, Carmon M, Nissan S, Freund HR (1993) How conservatively can postoperative small bowel obstruction be treated? Am J Surg 165:121–126PubMedCrossRefGoogle Scholar
  3. 3.
    Matter I, Khalemsky L, Abrahamson J, Nash E, Sabo E, Eldar S (1997) Does the index operation influence the course and outcome of adhesive intestinal obstruction? Eur J Surg 163:767–772PubMedGoogle Scholar
  4. 4.
    Choi HK, Chu KW, Law WL (2002) Therapeutic value of Gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg 236:1–6PubMedCrossRefGoogle Scholar
  5. 5.
    Chen SC, Lin FY, Lee PH, Yu SC, Wang SM, Chang KJ (1998) Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction. Br J Surg 85:1692–1694PubMedCrossRefGoogle Scholar
  6. 6.
    Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M (1994) Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery 115:433–437PubMedGoogle Scholar
  7. 7.
    Stordahl A, Laerum F, Gjolberg T, Enge I (1988) Water-soluble contrast media in radiography of small bowel obstruction. Comparison of ionic and non-ionic contrast media. Acta Radiol 29:53–56PubMedGoogle Scholar
  8. 8.
    Blackmon S, Lucius C, Wilson JP, Duncan T, Wilson R, Mason EM, Ramshaw B (2000) The use of water-soluble contrast in evaluating clinically equivocal small bowel obstruction. Am Surg 66:238–244PubMedGoogle Scholar
  9. 9.
    Fevang BT, Jensen D, Fevang J, Sondenaa K, Ovrebo K, Rokke O, Gislasson H, Svanes K, Viste A (2000) Upper gastrointestinal contrast study in the management of small bowel obstruction: a prospective randomised study. Eur J Surg 166:39–43PubMedCrossRefGoogle Scholar
  10. 10.
    Feigin E, Seror D, Szold A, Carmon M, Allweis TM, Nissan A, Gross E, Vromen A, Freund R (1996) Water-soluble contrast material has no therapeutic effect on postoperative small-bowel obstruction: results of a prospective, randomized clinical trial. Am J Surg 171:227–229PubMedCrossRefGoogle Scholar
  11. 11.
    Biondo S, Pares D, Mora L, Marti Rague J, Kreisler E, Jaurrieta E (2003) Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction. Br J Surg 90:542–546PubMedCrossRefGoogle Scholar
  12. 12.
    Skucas J (1997) Anaphylactoid reactions with gastrointestinal contrast media. AJR Am J Roentgenol 168:962–964PubMedGoogle Scholar
  13. 13.
    Ridley LJ (1998) Allergic reactions to oral iodinated contrast agents: reactions to oral contrast. Australas Radiol 42:114–117PubMedCrossRefGoogle Scholar
  14. 14.
    Trulzsch DV, Penmetsa A, Karim A, Evans DA (1992) Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography. South Med J 85:1255–1256PubMedCrossRefGoogle Scholar
  15. 15.
    Stordahl A, Laerum F, Giolberg T, Enge I (1988) Water-soluble contrast media in radiography of small bowel obstruction. Comparison of ionic and non-ionic contrast media. Acta Radiol 29:53–56PubMedGoogle Scholar
  16. 16.
    Joyce WP, Delaney PV, Gorey TF, Fitzpatrick JM (1992) The value of water-soluble contrast radiology in the management of acute small bowel obstruction. Ann R Coll Surg Engl 74:422–425PubMedGoogle Scholar
  17. 17.
    Chung CC, Meng WC, Yu SC, Leung KL, Lau WY, Li AK (1996) A prospective study on the use of water-soluble contrast follow-through radiology in the management of small bowel obstruction. ANZ J Surg 66:598–601CrossRefGoogle Scholar
  18. 18.
    Blackmon S, Lucius C, Wilson JP, Duncan T, Wilson R, Mason EM, Ramshaw B (2000) The use of water-soluble contrast in evaluating clinically equivocal small bowel obstruction. Am Surg 66:238–242PubMedGoogle Scholar
  19. 19.
    Onoue S, Katoh T, Shibata Y, Matsuo K, Suzuki M, Chigira H (2002) The value of contrast radiology for postoperative adhesive small bowel obstruction. Hepatogastroenterology 49:1576–1578PubMedGoogle Scholar
  20. 20.
    Choi HK, Law WL, Chu KW (2005) Value of Gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective evaluation. World J Gastroenterol 11:3742–3745PubMedGoogle Scholar
  21. 21.
    Brochwicz-Lewinski MJ, Paterson-Brown S, Murchison JT (2003) Small bowel obstruction: the water-soluble follow-through revisited. Clin Radiol 58:393–397PubMedCrossRefGoogle Scholar
  22. 22.
    Roadley G, Cranshaw I, Young M, Hill AG (2004) Role of Gastrografin in assigning patients to a non-operative course in adhesive small bowel obstruction. ANZ J Surg 74:830–832PubMedCrossRefGoogle Scholar
  23. 23.
    Yagci G, Kaymakcioglu N, Can MF, Peker Y, Cetiner S, Tufan T (2005) Comparison of Urografin versus standard therapy in postoperative small bowel obstruction. J Invest Surg 18:315–320PubMedCrossRefGoogle Scholar
  24. 24.
    Burge J, Abbas SM, Roadley G, Donald J, Connolly A, Bissett IP, Hill AG (2005) Randomized controlled trial of Gastrografin in adhesive small bowel obstruction. ANZ J Surg 75:672–674PubMedCrossRefGoogle Scholar
  25. 25.
    Kapoor S, Jain G, Sewkani A, Sharma S, Patel K, Varshney S (2006) Prospective evaluation of oral Gastrografin in postoperative small bowel obstruction. J Surg Res 131:256–260PubMedCrossRefGoogle Scholar
  26. 26.
    Practice management guidelines for small bowel obstruction (2007) Eastern Association for the Surgery of Trauma Practice Parameter Workgroup for Management of Small Bowel Obstruction. Available at: http://www.east.org
  27. 27.
    Thompson JS (2002) Contrast radiography and intestinal obstruction. Ann Surg 236:7–8PubMedCrossRefGoogle Scholar
  28. 28.
    Chen SC, Chang KJ, Lee PH, Wang SM, Chen KM, Lin FY (1999) Oral Urografin in postoperative small bowel obstruction. World J Surg 23:1051–1054PubMedCrossRefGoogle Scholar
  29. 29.
    Abbas S, Bisset IP, Parry BR (2005) Oral water-soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database Syst Rev 25:1Google Scholar
  30. 30.
    Abbas S, Bisset IP, Parry BR (2007) Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction. Br J Surg 94:404–411PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Salomone Di Saverio
    • 1
  • Fausto Catena
    • 1
  • Luca Ansaloni
    • 1
  • Margherita Gavioli
    • 2
  • Massimo Valentino
    • 3
  • Antonio Daniele Pinna
    • 1
  1. 1.Emergency Surgery Unit, Department of SurgeryS. Orsola Malpighi University Hospital, University of BolognaBolognaItaly
  2. 2.Emergency Surgery DepartmentUniversity of ModenaEmiliaItaly
  3. 3.Department of RadiologyS. Orsola Malpighi University HospitalBolognaItaly

Personalised recommendations