The Diagnostic and Therapeutic Value of Water-Soluble Contrast Agent in Small-Bowel Obstruction
The Diagnostic and Therapeutic Value of Water-Soluble Contrast Agent in Small-Bowel Obstruction
Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D
Br J Surg. 2010;97:470-478
Is the administration of water-soluble contrast agent (WSCA) of any diagnostic or therapeutic value in the management of small-bowel obstruction caused by adhesions? The authors conducted a meta-analysis based on the results of 14 prospective studies. In 508 patients (7 trials), WSCA accurately predicted resolution of small-bowel obstruction if the agent reached the large bowel within 4 to 24 hours. The combined results yielded a sensitivity of 96% and a specificity of 98%. Water-soluble contrast agent also seemed to have some therapeutic value: In 8 trials, administration of WSCA reduced the need for surgery by 38% (P = .007).
Small-bowel obstruction caused by adhesions is the most common form of intestinal obstruction, and deciding whether to operate has always been a surgical challenge. The obstruction will resolve spontaneously in many patients, but it has been difficult to predict which patients will eventually require surgery. This report found that oral WSCA accurately identifies patients who will not require surgery. The agent was not associated with complications, and it reduced the overall length of hospitalization by almost 2 days. The results suggest that if this procedure was widely used in the United States, approximately $700 million could be saved each year.
Abstract
Systematic Review and Meta-analysis of the Diagnostic and Therapeutic Role of Water-Soluble Contrast Agent in Adhesive SmallBowel Obstruction
Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D
Br J Surg. 2010;97:470-478
Summary
Is the administration of water-soluble contrast agent (WSCA) of any diagnostic or therapeutic value in the management of small-bowel obstruction caused by adhesions? The authors conducted a meta-analysis based on the results of 14 prospective studies. In 508 patients (7 trials), WSCA accurately predicted resolution of small-bowel obstruction if the agent reached the large bowel within 4 to 24 hours. The combined results yielded a sensitivity of 96% and a specificity of 98%. Water-soluble contrast agent also seemed to have some therapeutic value: In 8 trials, administration of WSCA reduced the need for surgery by 38% (P = .007).
Viewpoint
Small-bowel obstruction caused by adhesions is the most common form of intestinal obstruction, and deciding whether to operate has always been a surgical challenge. The obstruction will resolve spontaneously in many patients, but it has been difficult to predict which patients will eventually require surgery. This report found that oral WSCA accurately identifies patients who will not require surgery. The agent was not associated with complications, and it reduced the overall length of hospitalization by almost 2 days. The results suggest that if this procedure was widely used in the United States, approximately $700 million could be saved each year.
Abstract
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