This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Meta‐analysis of oral water‐soluble contrast agent in the management of adhesive small bowel obstruction. BJS 2007; 94: 404-411.
Published: 23rd March 2007
Authors: S. M. Abbas, I. P. Bissett, B. R. Parry
Background
Adhesions are the leading cause of small bowel obstruction. Identification of patients who require surgery is difficult. This review analyses the role of Gastrografin® as a diagnostic and therapeutic agent in the management of adhesive small bowel obstruction.
Method
A systematic search of Medline, Embase and Cochrane databases was performed to identify studies of the use of Gastrografin® in adhesive small bowel obstruction. Studies that addressed the diagnostic role of water‐soluble contrast agent were appraised, and data presented as sensitivity, specificity, and positive and negative likelihood ratios. Results were pooled and a summary receiver–operator characteristic (ROC) curve was constructed. A meta‐analysis of the data from six therapeutic studies was performed using the Mantel–Haenszel test and both fixed‐ and random‐effect models.
Results
The appearance of water‐soluble contrast agent in the colon on an abdominal radiograph within 24 h of its administration predicted resolution of obstruction with a pooled sensitivity of 97 per cent and specificity of 96 per cent. The area under the summary ROC curve was 0·98. Water‐soluble contrast agent did not reduce the need for surgical intervention (odds ratio 0·81, P = 0·300), but it did reduce the length of hospital stay for patients who did not require surgery compared with placebo (weighted mean difference − 1·84 days; P < 0·001).
Conclusion
Published data strongly support the use of water‐soluble contrast medium as a predictive test for non‐operative resolution of adhesive small bowel obstruction. Although Gastrografin® does not reduce the need for operation, it appears to shorten the hospital stay for those who do not require surgery. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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