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

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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; p < 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.

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References

  1. Playforth RH, Holloway JB, Griffen WO Jr (1970) Mechanical small bowel obstruction: a plea for earlier surgical intervention. Ann Surg 171:783–788

    Article  PubMed  CAS  Google Scholar 

  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 165:121–126

    Article  PubMed  CAS  Google Scholar 

  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 163:767–772

    PubMed  CAS  Google Scholar 

  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 236:1–6

    Article  PubMed  Google Scholar 

  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 85:1692–1694

    Article  PubMed  CAS  Google Scholar 

  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 115:433–437

    PubMed  CAS  Google Scholar 

  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 29:53–56

    PubMed  CAS  Google Scholar 

  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 66:238–244

    PubMed  CAS  Google Scholar 

  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 166:39–43

    Article  PubMed  CAS  Google Scholar 

  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 171:227–229

    Article  PubMed  CAS  Google Scholar 

  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 90:542–546

    Article  PubMed  CAS  Google Scholar 

  12. Skucas J (1997) Anaphylactoid reactions with gastrointestinal contrast media. AJR Am J Roentgenol 168:962–964

    PubMed  CAS  Google Scholar 

  13. Ridley LJ (1998) Allergic reactions to oral iodinated contrast agents: reactions to oral contrast. Australas Radiol 42:114–117

    Article  PubMed  CAS  Google Scholar 

  14. Trulzsch DV, Penmetsa A, Karim A, Evans DA (1992) Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography. South Med J 85:1255–1256

    Article  PubMed  CAS  Google Scholar 

  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 29:53–56

    PubMed  CAS  Google Scholar 

  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 74:422–425

    PubMed  CAS  Google Scholar 

  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 66:598–601

    Article  CAS  Google Scholar 

  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 66:238–242

    PubMed  CAS  Google Scholar 

  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 49:1576–1578

    PubMed  Google Scholar 

  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 11:3742–3745

    PubMed  CAS  Google Scholar 

  21. Brochwicz-Lewinski MJ, Paterson-Brown S, Murchison JT (2003) Small bowel obstruction: the water-soluble follow-through revisited. Clin Radiol 58:393–397

    Article  PubMed  CAS  Google Scholar 

  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 74:830–832

    Article  PubMed  Google Scholar 

  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 18:315–320

    Article  PubMed  Google Scholar 

  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 75:672–674

    Article  PubMed  Google Scholar 

  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 131:256–260

    Article  PubMed  CAS  Google Scholar 

  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. Thompson JS (2002) Contrast radiography and intestinal obstruction. Ann Surg 236:7–8

    Article  PubMed  Google Scholar 

  28. Chen SC, Chang KJ, Lee PH, Wang SM, Chen KM, Lin FY (1999) Oral Urografin in postoperative small bowel obstruction. World J Surg 23:1051–1054

    Article  PubMed  CAS  Google Scholar 

  29. Abbas S, Bisset IP, Parry BR (2005) Oral water-soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database Syst Rev 25:1

    Google Scholar 

  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 94:404–411

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Supported by the Department of Surgical and Anaesthesiological Sciences, University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy. The authors thank all the patients who participated in this trial and all the physicians and nurses whose work made the trial possible.

Author’s Contribution and Acknowledgments

Conception and Design of the Study: F. Catena, L. Ansaloni

Direction of the Clinical Trial: F. Catena

Provision of study materials or patients: F. Catena, L. Ansaloni, M. Gavioli, M. Valentino

Collection and Assembly of Data: F. Catena, L. Ansaloni, S. Di Saverio

Data Analysis and Interpretation: F. Catena, L. Ansaloni, S. Di Saverio

Manuscript Writing: S. Di Saverio, F. Catena, L. Ansaloni

Final Approval of Manuscript: S. Di Saverio, F. Catena, L. Ansaloni, M. Gavioli, M. Valentino, A.D. Pinna

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Authors and Affiliations

  1. Emergency Surgery Unit, Department of Surgery, S. Orsola Malpighi University Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Salomone Di Saverio, Fausto Catena, Luca Ansaloni & Antonio Daniele Pinna

  2. Emergency Surgery Department, University of Modena, Emilia, Italy

    Margherita Gavioli

  3. Department of Radiology, S. Orsola Malpighi University Hospital, Bologna, Italy

    Massimo Valentino

Authors
  1. Salomone Di Saverio
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  2. Fausto Catena
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  3. Luca Ansaloni
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  4. Margherita Gavioli
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  5. Massimo Valentino
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  6. Antonio Daniele Pinna
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Corresponding author

Correspondence to Salomone Di Saverio.

Additional information

ClinicalTrials.gov IDentifier: NCT00601809.

This paper has been selected for and presented in the Lloyd M. Nyhus Prize session, Best Free Papers in gastrointestinal surgery, during the 2007 International Surgical Week conference in Montreal, Canada and it has been awarded by a jury of internationally recognized experts with the 2nd Prize for the Best ISS/SIC Free Paper presentation.

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Di Saverio, S., Catena, F., Ansaloni, L. et al. Water-Soluble Contrast Medium (Gastrografin) Value in Adhesive Small Intestine Obstruction (Asio): A Prospective, Randomized, Controlled, Clinical Trial. World J Surg 32, 2293–2304 (2008). https://doi.org/10.1007/s00268-008-9694-6

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  • DOI: https://doi.org/10.1007/s00268-008-9694-6

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