Value of gastrografin in adhesive small bowel obstruction
Scott E. Greenway
Received: 9 March 2017 / Accepted: 14 July 2017 /Published online: 2 August 2017
Springer-Verlag GmbH Germany 2017
Background Small bowel obstruction (SBO) from adhesive
disease presents great burden for the healthcare system.
Some groups have reported water soluble contrast agents
(WSCA) protocols, but published studies are underpowered.
This study introduces a WSCA protocol to improve outcomes
and streamline patient care.
Study design The study ran July 1, 2013–June 30, 2015, at
Kaiser Permanente San Diego; protocol started July 1, 2014.
Data was collected prospectively, on an intention to treat basis.
We excluded patients whose SBO were not due to adhesive
disease. Protocol included nasogastric tube, intravenous resus-
citation, liquid docusate, and gastrografin study if symptoms
persisted at 24 h. Colon contrast determined resolution vs
operative consideration. Primary outcomes were operative
rates and hospital length of stay (LOS).
Results Seven hundred fifteen were patients admitted with
SBO; after exclusions there were 261 pre-protocol and 243
protocol patients. One hundred sixty patients resolved within
24 h; 96% of remaining patients stayed on protocol (n =154).
After WSCA protocol began, 15.6% required an operation,
compared to 19.8% of pre-protocol patients (NS). The
WSCA protocol significantly decreased the time to surgery
(2.8 vs 4.88 days, p = 0.03), and the LOS of operated patients
(9.51 vs 15.78 days, p =0.02).
Conclusions A standardized SBO protocol using WSCA sig-
nificantly decreased time to operation and hospital LOS. This
approach improves utilization of resources and may improve
outcomes. More work should be done to investigate the pos-
itive effects of WSCA protocol for patients with SBO.
Keywords Water-soluble contrast use in small bowel
Treatment of small bowel
Gastrografin in small bowel obstruction
Adhesive disease is among the most common disorders of the
small intestine, and as such comprises a great burden both on
patients and on the medical community [1–6].Although it is
impossible to determine the true incidence of adhesions be-
cause not all become clinically significant, some suggest al-
most all patients who undergo an operation will develop ad-
hesions . Sequelae of these adhesions can be small bowel
obstruction (SBO), pain, or infertility [3, 5]. It is estimated that
about one third of patients will require admission , and
anywhere from 15 to 24% of patients will need an operative
intervention for these sequelae in their lifetime [2, 5]. In a
systematic review which included almost 108,000 patients,
the incidence of post-operative adhesive small bowel obstruc-
tion was 2.4%, and the lifetime risk of operation for SBO was
10% . This same study also revealed a mean hospital stay of
7.8 days and an in-hospital mortality secondary to small bowel
obstruction of 2.5%. A population-based study of over 32,000
patients revealed that 24% of index admissions for SBO
underwent surgical intervention, and readmission rates were
16 and 20% for operative and non-operative management,
Presented at the American College of Surgeons Clinical Congress,
Washington DC, October 20, 2016
* Anna Weiss
Brigham and Women’s Hospital, Boston, MA, USA
Department of Surgery, University of California San Diego, San
Diego, CA, USA
Department of Surgery, Kaiser Permanente San Diego, San
Diego, CA, USA
Langenbecks Arch Surg (2017) 402:1233–1239