NDLI: Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction.

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Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction.

Content Provider	Semantic Scholar
Author	Zielinski, Martin Donald Haddad, Nadeem N. Cullinane, Daniel C. Inaba, Kenji Yeh, Dante D. Wydo, Salina M. Turay, David Pakula, Andrea M. Duane, Therese Marie Watras, Jill Widom, Kenneth A. Cull, John David Rodríguez, Carlos Javier Acurio Toschlog, Eric A. Sams, Valerie G. Hazelton, Joshua P. Graybill, John Christopher Skinner, Ruby A. Yune, Ji-Ming
Copyright Year	2017
Abstract	INTRODUCTION Existing trials studying the use of Gastrografin for management of adhesive small bowel obstruction (SBO) are limited by methodological flaws and small sample sizes. We compared institutional protocols with and without Gastrografin (GG), hypothesizing that a SBO management protocol utilizing GG is associated with lesser rates of exploration, shorter length of stay, and fewer complications. METHODS A multi-institutional, prospective, observational study was performed on patients appropriate for GG with adhesive SBO. Exclusion criteria were internal/external hernia, signs of strangulation, history of abdominal/pelvic malignancy, or exploration within the past 6 weeks. Patients receiving GG were compared to patients receiving standard care without GG. RESULTS Overall, 316 patients were included (58 ± 18 years; 53% male). There were 173 (55%) patients in the GG group (of whom 118 [75%] successfully passed) and 143 patients in the non-GG group. There were no differences in duration of obstipation (1.6 vs. 1.9 days, p = 0.77) or small bowel feces sign (32.9% vs. 25.0%, p = 0.14). Fewer patients in the GG protocol cohort had mesenteric edema on CT (16.3% vs. 29.9%; p = 0.009). There was a lower rate of bowel resection (6.9% vs. 21.0%, p < 0.001) and exploration rate in the GG group (20.8% vs. 44.1%, p < 0.0001). GG patients had a shorter duration of hospital stay (4 IQR 2-7 vs. 5 days IQR 2-12; p = 0.036) and a similar rate of complications (12.5% vs. 17.9%; p = 0.20). Multivariable analysis revealed that GG was independently associated with successful nonoperative management. CONCLUSION Patients receiving Gastrografin for adhesive SBO had lower rates of exploration and shorter hospital length of stay compared to patients who did not receive GG. Adequately powered and well-designed randomized trials are required to confirm these findings and establish causality. LEVEL OF EVIDENCE Therapeutic, level III.
Starting Page	47
Ending Page	54
Page Count	8
File Format	PDF HTM / HTML
Alternate Webpage(s)	https://www.east.org/content/documents/01_zielinski_multi-institutional_prospective_observational.pdf
PubMed reference number	28422909v1
Alternate Webpage(s)	https://doi.org/10.1097/TA.0000000000001499
DOI	10.1097/TA.0000000000001499
Journal	The journal of trauma and acute care surgery
Volume Number	83
Issue Number	1
Language	English
Access Restriction	Open
Subject Keyword	Abdominal Abscess Adhesives Constipation Death by strangulation Excision Feces Gastrografin Intestinal Obstruction Intestines Intestines, Small Mesentery Neoplasms Non-Small Cell Lung Carcinoma Numerous Patients Protocols documentation Pulmonary Edema Sample Size Small Intestinal Wall Tissue Small bowel obstruction bowel resection
Content Type	Text
Resource Type	Article

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