Use of the Water-Soluble Contrast Medium Gastrografin in Treatment of Adhesive Small Bowel Obstruction in Patients with and Without Chronic Radiation Enteropathy: A Single-Center Retrospective Study

A systematic review of participant descriptors reported in studies of adhesive small bowel obstruction

AIM

Reporting of participant descriptors in studies of adhesive small bowel obstruction (ASBO) can help identify characteristics associated with favourable outcomes and allow comparison with other studies and real-world clinical populations. The aim was to identify the pattern of participant descriptors reported in studies assessing interventions for ASBO.

METHOD

This systematic review was registered with PROSPERO (CRD42021281031) and reported in line with the PRISMA checklist. Systematic searches of Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were undertaken to identify studies assessing operative and non-operative interventions for adults with ASBO. Studies were dual screened for inclusion. Descriptors were categorised into conceptual domains by the research team.

RESULTS

Searches identified 2648 studies, of which 73 were included. A total of 156 unique descriptors were identified. On average, studies reported 12 descriptors. The most frequently reported descriptors were sex, age, SBO aetiology, history of abdominal surgery, BMI and ASA classification. The highest number of descriptors in a single study was 34, compared to the lowest number of descriptors which was one. Pathway factors were the least frequently described domain. Overall, 37 descriptors were reported in just one study.

CONCLUSION

There is a lack of consistency in participant descriptors reported in studies of SBO. Furthermore, a significant proportion of the descriptors were used infrequently. This makes it challenging to assess whether study participants are representative of the wider population. Further work is required to develop a Core Descriptor Set to standardise the reporting of patient characteristics and reduce heterogeneity between studies.

Clinical value of radiography after transnasal ileus intubation for the surgical timing of small bowel obstruction

OBJECTIVE

To explore the guiding value of radiography after transnasal ileus intubation for the treatment of small bowel obstruction and the selection of surgical timing.

METHODS

This retrospective study analyzed the clinical data of 133 patients with small bowel obstruction who were admitted to Gongli Hospital from January 2013 to December 2020. The patients were included in a nasogastric intubation group (n=65) or a transnasal ileus intubation + radiography group (n=68), according to different treatment methods. The response rate of non-surgical treatment, bowel function, observation time before surgery, postoperative complications and the recurrence rate were observed in both groups.

RESULTS

There was no significant difference in the response rate of non-surgical treatment and the incidence of postoperative complications between the two groups (P=0.257 and P=0.959, respectively). The observation time before surgery was shorter and the recurrence rate of obstruction was lower in the transnasal ileus intubation + radiography group than those in the nasogastric intubation group. The pain relief time, first flatus time and hospital stay were shorter in the transnasal ileus intubation + radiography group than those in the nasogastric intubation group, with statistically significant differences (all P<0.05). It was found that ascites and observation time before surgery were the influencing factors of surgical timing in patients with small bowel obstruction.

CONCLUSION

Transnasal ileus intubation is an effective treatment for small bowel obstruction. Radiography after transnasal ileus intubation is helpful to determine the optimal surgical timing for small bowel obstruction, shorten the postoperative recovery time and reduce the recurrence rate in patients, so it is recommended in clinical practice.

Long-term outcomes of nasogastric tube with Gastrografin for adhesive small bowel obstruction

BACKGROUND

We had previously reported that the administration of Gastrografin through a nasogastric tube (NGT-G) followed by long tube (LT) strategy could be a novel standard treatment for adhesive small bowel obstruction (ASBO); however, the long-term outcomes after initial improvement remain unknown. This study aimed to analyze the long-term outcomes of first-line NGT-G.

METHODS

Enrolled patients with ASBO were randomly assigned to receive LT or NGT-G between July 2016 and November 2018. Thereafter, the cumulative surgery rate, cumulative recurrence rate, and overall survival (OS) rate were analyzed. In addition, subset analysis was conducted to determine the cumulative recurrence rate according to colonic contrast with Gastrografin at 24 h.

RESULTS

A total of 223 patients (LT group, n = 111; NGT-G group, n = 112) were analyzed over a median follow-up duration of 550 days. The cumulative 1-year surgery rates, cumulative 1-year recurrence rates, and 1-year OS rates in the LT and NGT-G groups were 18.8% and 18.1%, 30.0% and 31.7%, and 99.1% and 96.6%, respectively; no significant differences were observed between both groups. In the NGT-G group, a negative colonic contrast at 24 h demonstrated a higher tendency for future recurrence compared with a positive colonic contrast at 24 h (1-year recurrence rate: negative contrast, 46.9% vs positive contrast, 27.6%).

CONCLUSIONS

Gastrografin through a nasogastric tube followed by LT can be a promising treatment strategy for ASBO, with long-term efficacies equivalent to initial LT placement.