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Starr N, Tadesse M, Igwebuike C, Sherefa K, Genetu A, Aregawi Y, Zewdu E, Tamirat D, Desalegn M, Getahun B, Harris H, Zemenfes D. Feasibility of Gastrografin Use for Adhesive Small Bowel Obstruction in Low-Income Countries. J Surg Res 2024; 293:239-247. [PMID: 37802018 DOI: 10.1016/j.jss.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 07/15/2023] [Accepted: 08/23/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Small bowel obstruction (SBO) is one of the most common causes for hospital admission in Ethiopia. The use of water-soluble contrast agents (WSCAs) such as Gastrografin to manage adhesive SBO can predict nonoperative resolution of SBO and reduce decision time to surgery and length of hospital stay. However, nothing is known about practice patterns and Gastrografin use in low-income settings. We sought to characterize current management practices, including use of WSCAs, as well as outcomes for patients with SBO in Addis Ababa, Ethiopia. METHODS We conducted a mixed-methods study consisting of a survey of surgeons throughout Ethiopia and a retrospective record review at five public, tertiary care-level teaching hospitals in Addis Ababa. RESULTS Of the 76 surgeons who completed the survey, 63% had heard of the use of WSCAs for SBO and only 11% used oral agents for its management. Chart review of 149 patients admitted with SBO showed the most common etiology was adhesion (39.6% of admissions), followed by small bowel volvulus (20.8%). Most patients (83.2%) underwent surgery during their admission. The most common diagnosis in patients who did not require surgery was also adhesion (68.0%), as well as for those who had surgery (33.9%), followed by small bowel volvulus (24.2%). CONCLUSIONS The etiology of SBO in Ethiopia may be changing, with postoperative adhesions becoming more common than other historically more prevalent causes. Although a Gastrografin protocol as a diagnostic and potentially therapeutic aid for SBO is feasible in this population and setting, challenges can be anticipated, and future studies of protocol implementation and effectiveness are needed to further inform its utility in Ethiopia and other low-income and middle-income countries.
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Affiliation(s)
- Nichole Starr
- Department of Surgery, University of California, San Francisco, San Francisco, California.
| | - Mekdim Tadesse
- Department of Surgery, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Kalid Sherefa
- Department of Surgery, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | - Abraham Genetu
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohanna Aregawi
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ebenezer Zewdu
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Tamirat
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Migbar Desalegn
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bantie Getahun
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hobart Harris
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Daniel Zemenfes
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
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Dane B, Huang C, Luk L, Ream J, Fletcher JG, Baker M. Contrast enema, CT, and small bowel series of the ileal pouch. Abdom Radiol (NY) 2023; 48:2935-2943. [PMID: 37043026 DOI: 10.1007/s00261-023-03903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
This manuscript is part of the ileal pouch symposium and will describe the water-soluble contrast enema, CT, and small bowel series. MRI and other imaging modalities are discussed elsewhere in the symposium. Water-soluble contrast enema and CT are excellent for the evaluation of the ileal pouch. Contrast enema and CT with anal contrast administration can allow for anastomotic integrity and pouch assessment. Pre-pouch ileum, extra-intestinal manifestations, and acute symptomatology are best assessed with CT. The contrast small bowel examination is of limited utility in pouch patients and should not be performed. Indications, imaging technique, and anatomic pouch assessment with water-soluble contrast enema, CT, and contrast small bowel examination will be reviewed here.
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Affiliation(s)
- Bari Dane
- NYU Langone Health, 660 1st Avenue, NewYork, NY, 10016, USA.
| | - Chenchan Huang
- NYU Langone Health, 660 1st Avenue, NewYork, NY, 10016, USA
| | - Lyndon Luk
- Columbia University, 622 West 168th Street, New York, NY, 10032, USA
| | - Justin Ream
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | | | - Mark Baker
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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3
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The Use of Enteric Contrast in the Emergency Setting. Radiol Clin North Am 2023; 61:37-51. [PMID: 36336390 DOI: 10.1016/j.rcl.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fleites O, Pelenyi S, Pena K, Tiesenga F, Jorge J. Atypical Small Bowel Obstruction Caused by Perforated Cecum: A Case Report. Cureus 2022; 14:e27863. [PMID: 36110454 PMCID: PMC9462597 DOI: 10.7759/cureus.27863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
Acute onset of abdominal pain with emesis and lack of stool or flatus is an alarming presentation for possible small bowel obstruction (SBO). SBO should be high on the differential diagnosis due to concomitant signs and symptoms that are highly sensitive in diagnosing SBO. These include diffuse tenderness on palpation of the abdomen, abdominal distention, hypotension, vomiting, and lack of flatus or stool. In this report, we present a 67-year-old African American male, who presented to the emergency department with the above-mentioned signs and symptoms and decreased oral intake for four days, ultimately undergoing surgical exploration to relieve the SBO caused by an idiopathic cecal perforation. This case report calls attention to the decision-making, standard protocol, and surgical intervention of a patient with SBO.
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Lawrence EM, Pickhardt PJ. Evaluating suspected small bowel obstruction with the water-soluble contrast challenge. Br J Radiol 2022; 95:20210791. [PMID: 34826227 PMCID: PMC8822578 DOI: 10.1259/bjr.20210791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
With optimized technique, the water-soluble contrast challenge is effective at triaging patients for operative vs non-operative management of suspected small bowel obstruction. Standardized study structure and interpretation guidelines aid in clinical efficacy and ease of use. Many tips and tricks exist regarding technique and interpretation, and their understanding may assist the interpreting radiologist. In the future, a CT-based water-soluble contrast challenge, utilizing oral contrast given as part of the initial CT examination, might allow for a more streamlined algorithm and provide more rapid results.
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Affiliation(s)
- Edward M. Lawrence
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Perry J. Pickhardt
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Chang KJ, Marin D, Kim DH, Fowler KJ, Camacho MA, Cash BD, Garcia EM, Hatten BW, Kambadakone AR, Levy AD, Liu PS, Moreno C, Peterson CM, Pietryga JA, Siegel A, Weinstein S, Carucci LR. ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction. J Am Coll Radiol 2020; 17:S305-S314. [PMID: 32370974 DOI: 10.1016/j.jacr.2020.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 01/29/2023]
Abstract
Small-bowel obstruction is a common cause of abdominal pain and accounts for a significant proportion of hospital admissions. Radiologic imaging plays the key role in the diagnosis and management of small-bowel obstruction as neither patient presentation, the clinical examination, nor laboratory testing are sufficiently sensitive or specific enough to diagnose or guide management. This document focuses on the imaging evaluation of the two most commonly encountered clinical scenarios related to small-bowel obstruction: the acute presentation and the more indolent, low-grade, or intermittent presentation. This document hopes to clarify the appropriate utilization of the many imaging procedures that are available and commonly employed in these clinical settings. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts.
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California
| | - Marc A Camacho
- The University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Benjamin W Hatten
- University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado; American College of Emergency Physicians
| | | | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia
| | | | | | | | | | - Alan Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Ong AW, Myers SR. Early postoperative small bowel obstruction: A review. Am J Surg 2020; 219:535-539. [DOI: 10.1016/j.amjsurg.2019.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 01/30/2023]
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Thornblade LW, Verdial FC, Bartek MA, Flum DR, Davidson GH. The Safety of Expectant Management for Adhesive Small Bowel Obstruction: A Systematic Review. J Gastrointest Surg 2019; 23:846-859. [PMID: 30788717 PMCID: PMC6988581 DOI: 10.1007/s11605-018-4017-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/18/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical training has long been to "never let the sun set on a bowel obstruction" without an operation to rule out and/or treat compromised bowel. However, advances in diagnostics have called into question the appropriate timing of non-emergent operations and expectant management is increasingly used. We performed a systematic review to evaluate the safety and effectiveness of expectant management for adhesive small bowel obstruction (aSBO) compared to early, non-emergent operation. MATERIALS & METHODS We queried PubMed, EMBASE, and Cochrane databases for studies (1990-present) comparing early, non-emergent operations and expectant management for aSBO (PROSPERO #CRD42017057676). RESULTS Of 4873 studies, 29 cohort studies were included for full-text review. Four studies directly compared early surgery with expectant management, but none excluded patients who underwent emergent operations from those having early non-emergent surgery, precluding a direct comparison of the two treatment types of interest. When aggregated, the rate of bowel resection was 29% in patients undergoing early operation vs. 10% in those undergoing expectant management. The rate of successful, non-operative management in the expectant group was 58%. There was a 1.3-day difference in LOS favoring expectant management (LOS 9.7 vs. 8.4 days), and the rate of death was 2% in both groups. CONCLUSION Despite the shift towards expectant management of aSBO, no published studies have yet compared early, non-emergent operation and expectant management. A major limitation in evaluating the outcomes of these approaches using existing studies is confounding by indication related to including patients with emergent indications for surgery on admission in the early operative group. A future study, randomizing patients to early non-emergent surgery or expectant management, should inform the comparative safety and value of these approaches.
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Affiliation(s)
- Lucas W Thornblade
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, 1107 NE 45th Street, Suite 502, Seattle, WA, 98105, USA
| | - Francys C Verdial
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, 1107 NE 45th Street, Suite 502, Seattle, WA, 98105, USA
| | - Matthew A Bartek
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, 1107 NE 45th Street, Suite 502, Seattle, WA, 98105, USA.
| | - David R Flum
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, 1107 NE 45th Street, Suite 502, Seattle, WA, 98105, USA
| | - Giana H Davidson
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, 1107 NE 45th Street, Suite 502, Seattle, WA, 98105, USA
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Long B, Robertson J, Koyfman A. Emergency Medicine Evaluation and Management of Small Bowel Obstruction: Evidence-Based Recommendations. J Emerg Med 2018; 56:166-176. [PMID: 30527563 DOI: 10.1016/j.jemermed.2018.10.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Small bowel obstruction (SBO) is a commonly diagnosed disease in the emergency department (ED). Recent literature has evaluated the ED investigation and management of SBO. OBJECTIVE This review evaluates the ED investigation and management of adult SBO based on the current literature. DISCUSSION SBO is most commonly due to occlusion of the small intestine, resulting in fluid and gas accumulation. This may progress to mucosal ischemia, necrosis, and perforation. A variety of etiologies are present, but in adults, adhesions are the most common cause. Several classification systems are present. However, the most important distinction is complete vs. partial and complicated vs. simple obstruction, as complete complicated SBO more commonly requires surgical intervention. History and physical examination can vary, but the most reliable findings include prior abdominal surgery, history of constipation, abdominal distension, and abnormal bowel sounds. Signs of strangulation include fever, hypotension, diffuse abdominal pain, peritonitis, and several others. Diagnosis typically requires imaging, and though plain radiographs are often ordered, they cannot exclude the diagnosis. Computed tomography and ultrasound are reliable diagnostic methods. Management includes intravenous fluid resuscitation, analgesia, and determining need for operative vs. nonoperative therapy. Nasogastric tube is useful for patients with significant distension and vomiting by removing contents proximal to the site of obstruction. Surgery is needed for strangulation and those that fail nonoperative therapy. Surgical service evaluation and admission are recommended. CONCLUSION SBO is a common reason for admission from the ED. Knowledge of recent literature can optimize diagnosis and management.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | | | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Gu L, Ding C, Tian H, Yang B, Zhang X, Hua Y, Gong J, Li N. Use of gastrografin in the management of faecal impaction in patients with severe chronic constipation: a randomized clinical trial. ANZ J Surg 2018; 89:239-243. [PMID: 30294848 DOI: 10.1111/ans.14863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/11/2018] [Accepted: 08/23/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIM Faecal impaction (FI) is a common cause of lower gastrointestinal tract obstruction. Gastrografin is a water-soluble radiologic contrast agent that may be orally or rectally administered, with proved therapeutic benefits in adhesive small bowel obstruction. Enemas have long been advocated as the best treatment for FI. The purpose of this study was to demonstrate that enteral administration of gastrografin might be more effective than enema in FI treatment inducing intestinal obstruction. METHODS A double-blinded, controlled and randomized trial was conducted. Participants received 100 mL of gastrografin (gastrografin group) through nasointestinal tube or enemas (enema group) once daily for six consecutive days. Successful faecal disimpaction, FI time to resolution, Bristol Stool Scale, constipation severity, symptom assessment and adverse events were evaluated. RESULTS A total of 124 patients were eligible, but only 83 were enrolled to this trial (mean age: 44 ± 15.8 years). Forty-two patients received enemas, and 41 patients received gastrografin, with six dropouts in each group. Successful disimpaction was achieved with enemas (69.44%) and gastrografin (88.57%; P = 0.034), mean duration of impaction was strikingly different between the two groups (67.13 versus 31.67, respectively; P < 0.01). Constipation severity and symptom assessment were significantly reduced in the gastrografin group. CONCLUSION Gastrografin given through nasointestinal tube was more effective than enema in the treatment of FI inducing colon obstruction. Gastrografin might be taken into consideration as an effective and safe therapeutic option for FI.
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Affiliation(s)
- Lili Gu
- Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Chao Ding
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongliang Tian
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Bo Yang
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Xuelei Zhang
- Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yue Hua
- Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jianfeng Gong
- Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ning Li
- Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China
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Bower KL, Lollar DI, Williams SL, Adkins FC, Luyimbazi DT, Bower CE. Small Bowel Obstruction. Surg Clin North Am 2018; 98:945-971. [PMID: 30243455 DOI: 10.1016/j.suc.2018.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Identifying patients with small bowel obstruction who need operative intervention and those who will fail nonoperative management is a challenge. Without indications for urgent intervention, a computed tomography scan with/without intravenous contrast should be obtained to identify location, grade, and etiology of the obstruction. Most small bowel obstructions resolve with nonoperative management. Open and laparoscopic operative management are acceptable approaches. Malnutrition needs to be identified early and managed, especially if the patient is to undergo operative management. Confounding conditions include age greater than 65, post Roux-en-Y gastric bypass, inflammatory bowel disease, malignancy, virgin abdomen, pregnancy, hernia, and early postoperative state.
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Affiliation(s)
- Katie Love Bower
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA.
| | - Daniel I Lollar
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA
| | - Sharon L Williams
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA
| | - Farrell C Adkins
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA
| | - David T Luyimbazi
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA
| | - Curtis E Bower
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA
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Milne TGE, Vather R, O'Grady G, Miquel J, Biondo S, Bissett I. Gastrografin may reduce time to oral diet in prolonged post-operative ileus: a pooled analysis of two randomized trials. ANZ J Surg 2018; 88. [PMID: 29510463 DOI: 10.1111/ans.14443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/09/2018] [Accepted: 01/13/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gastrografin has been suggested as a rescue therapy for prolonged post-operative ileus (PPOI) but trial data has been inconclusive. This study aimed to determine the benefit of gastrografin use in patients with PPOI by pooling the results of two recent randomized controlled trials assessing the efficacy of gastrografin compared to placebo given at time of PPOI diagnosis. METHODS Anonymized, individual patient data from patients undergoing elective bowel resection for any indication were included, stoma closure was excluded. The primary outcome was duration of PPOI. Secondary outcomes were time to tolerate oral diet, passage of flatus/stool, requirement and duration of nasogastric tube, length of post-operative stay and rate of post-operative complications. RESULTS Individual patient data were pooled for analysis (53 gastrografin, 55 placebo). Gastrografin trended towards a reduction in PPOI duration compared to placebo, respectively, median 96 h (interquartile range, IQR, 78 h) versus median 120 h (IQR, 84 h), however, this result was non-significant (P = 0.11). In addition, no significant difference was detected between the two groups for time to passage of flatus/stool (P = 0.36) and overall length of stay (P = 0.35). Gastrografin conferred a significantly faster time to tolerate an oral diet compared to placebo (median 84 h versus median 107 h, P = 0.04). There was no difference in post-operative complications between the two interventions (P > 0.05). CONCLUSION Gastrografin did not significantly reduce PPOI duration or length of stay after abdominal surgery, but did reduce time to tolerate a solid diet. Further studies are required to clarify the role of gastrografin in PPOI.
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Affiliation(s)
- Tony G E Milne
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Ryash Vather
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Colorectal Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Jordi Miquel
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Sebastiano Biondo
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Ian Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Colorectal Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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Weiss A, Sood D, Greenway SE, Tomassi M. Value of gastrografin in adhesive small bowel obstruction. Langenbecks Arch Surg 2017; 402:1233-1239. [PMID: 28770343 DOI: 10.1007/s00423-017-1605-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/14/2017] [Indexed: 12/16/2022]
Abstract
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 resuscitation, 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 significantly 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 positive effects of WSCA protocol for patients with SBO.
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Affiliation(s)
- Anna Weiss
- Brigham and Women's Hospital, Boston, MA, USA.
| | - Divya Sood
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Scott E Greenway
- Department of Surgery, Kaiser Permanente San Diego, San Diego, CA, USA
| | - Marco Tomassi
- Department of Surgery, Kaiser Permanente San Diego, San Diego, CA, USA
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14
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Validation of the anatomic severity score developed by the American Association for the Surgery of Trauma in small bowel obstruction. J Surg Res 2016; 204:428-434. [DOI: 10.1016/j.jss.2016.04.076] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 03/14/2016] [Accepted: 04/29/2016] [Indexed: 12/31/2022]
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15
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Martinez A, Goldberg RF, Dixon RM, Thomas EL, Davis KM, Bogert JN. Implementation of a small bowel obstruction protocol at an urban public hospital. SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Martinez
- Department of Grants and Research; Maricopa Medical Center; Phoenix Arizona USA
| | - Ross F. Goldberg
- Division of General Surgery, Department of Surgery; Maricopa Medical Center; Phoenix Arizona USA
| | - Robert M. Dixon
- Division of General Surgery, Department of Surgery; Maricopa Medical Center; Phoenix Arizona USA
| | - Eric L. Thomas
- Division of General Surgery, Department of Surgery; Maricopa Medical Center; Phoenix Arizona USA
| | - Karole M. Davis
- Division of Trauma/Critical Care, Department of Surgery; Maricopa Medical Center; Phoenix Arizona USA
| | - James N. Bogert
- Division of Trauma/Critical Care, Department of Surgery; Maricopa Medical Center; Phoenix Arizona USA
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Baghdadi YMK, Choudhry AJ, Goussous N, Khasawneh MA, Polites SF, Zielinski MD. Long-term outcomes of gastrografin in small bowel obstruction. J Surg Res 2015; 202:43-8. [PMID: 27083946 DOI: 10.1016/j.jss.2015.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND The gastrografin (GG) challenge is a diagnostic and therapeutic tool used to treat patients with small bowel obstruction (SBO); however, long-term data on SBO recurrence after the GG challenge remain limited. We hypothesized that patients treated with GG would have the same long-term recurrence as those treated before the implementation of the GG challenge protocol. METHODS Patients ≥18 years who were treated for SBO between July 2009 and December 2012 were identified. We excluded patients with contraindications to the GG challenge (i.e., signs of strangulation), patients having SBO within 6-wk of previous abdominal or pelvic surgery and patients with malignant SBO. All patients had been followed a minimum of 1 y or until death. Kaplan-Meier method and Cox regression models were used to describe the time-dependent outcomes. RESULTS A total of 202 patients were identified of whom 114 (56%) received the challenge. Mean patients age was 66 y (range, 19-99 y) with 110 being female (54%). A total of 184 patients (91%) were followed minimum of 1 year or death (18 patients lost to follow-up). Median follow-up of living patients was 3 y (range, 1-5 y). During follow-up, 50 patients (25%) experienced SBO recurrences, and 24 (12%) had exploration for SBO recurrence. The 3-year cumulative rate of SBO recurrence in patients who received the GG was 30% (95% confidence interval [CI], 21%-42%) compared to 27% (95% CI, 18%-38%) for those who did not (P = 0.4). The 3-year cumulative rate of exploration for SBO recurrence in patients who received the GG was 15% (95% CI, 8%-26%) compared to 12 % (95% CI, 6%-22%) for those who did not (P = 0.6). CONCLUSIONS The GG challenge is a clinically useful tool in treating SBO patients with comparable long-term recurrence rates compared to traditional management of SBO.
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Affiliation(s)
- Yaser M K Baghdadi
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Asad J Choudhry
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Naeem Goussous
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammad A Khasawneh
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Stephanie F Polites
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Martin D Zielinski
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota.
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Mei LJ, Wang LW, Huang CQ, Yang XJ, Li Y. Oral gastrografin radiography for the evaluation of the functional impact of peritoneal carcinomatosis: Correlation with clinicopathological findings. Mol Clin Oncol 2015; 3:979-986. [PMID: 26623037 DOI: 10.3892/mco.2015.573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/15/2015] [Indexed: 02/06/2023] Open
Abstract
This study was conducted to evaluate the functional impact of peritoneal carcinomatosis (PC) on the gastrointestinal system by oral gastrografin radiography (OGR). OGR was performed on 105 patients with PC from abdominal malignancies. The OGR characteristics were analyzed and compared with intraoperative observations. OGR provided real-time dynamic information on the functional impacts of PC. The OGR findings were normal in 9 (8.6%) and abnormal in 96 (91.4%) cases. In terms of frequency, 33 cases (31.4%) exhibited mild intestinal aggregation and flattening of the intestinal mucosa; 29 cases (27.6%) exhibited limited intestinal invasion, marginally stenotic small bowel and mucosal deformities; 26 cases (24.8%) exhibited only mild mesenteric contracture and mild slowing of gastrointestinal peristalsis; 5 cases (4.8%) exhibited obvious mesenteric contracture, ball-like changes, fixed position and disappearance of the intestinal mucosa; 2 cases (1.9%) exhibited complete pyloric obstruction; and 1 case (0.9%) exhibited duodenal obstruction. Gastric PC was associated with a higher percentage of stomach filling defects and small intestinal aggregates compared with PC from other malignancies (P<0.01 for both). In 87 cases, the ORG findings were in accordance with the intraoperative findings (κ=0.726, P<0.001), whereas 17 cases (16.2%) were underestimated and 1 (0.9%) was overestimated by OGR. This study indicated that OGR may be a useful technique for the evaluation of the functional impacts of PC on the gastrointestinal system and may help optimize the selection of patients for treatment.
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Affiliation(s)
- Lie-Jun Mei
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China ; Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Lin-Wei Wang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China ; Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China
| | - Chao-Qun Huang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China ; Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China
| | - Xiao-Jun Yang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China ; Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China
| | - Yan Li
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China ; Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China
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