A significant proportion of small bowel obstructions require >48 hours to resolve after gastrografin

Michelle B. Mulder, Matthew Hernandez, Mohamed Ray-Zack, Daniel C. Cullinane, David Turay, Salina Wydo, Martin Zielinski, D. Dante Yeh

Research output: Contribution to journalArticle

Abstract

Background: Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen. Methods: A post hoc analysis of an Eastern Association for the Surgery of Trauma multi-institutional SBO database was performed including only those receiving GG challenge. Successful nonoperative management (NOM) was defined as passage of flatus or nasogastric tube (NGT) removal. NOM was considered a failure if operative intervention was required. Multiple logistic regression was performed to identify predictors of delayed (>48 h) GG challenge effect and expressed as odds ratios with 95% confidence intervals. Results: Of 286 patients receiving GG, 208 patients (73%) were successfully managed nonoperatively. A total of 60 (29%) NOM patients had NGT decompression for >48 h (n = 54) or required >48 h to pass flatus (n = 34), with some requiring both (n = 28). Prior abdominal operations and SBO admission were protective of delayed GG effect (0.411 [0.169-1.00], P < 0.05; 0.478 [0.240-0.952], P < 0.036). Conclusions: A significant proportion of patients at 48 h (29%) “failed” the GG challenge as they had yet to pass flatus or still required NGT but were nonetheless successfully managed nonoperatively. Extending the GG challenge beyond 48 h may help avoid unnecessary operations. Level of evidence: Level II.

Original languageEnglish (US)
Pages (from-to)408-412
Number of pages5
JournalJournal of Surgical Research
Volume233
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Diatrizoate Meglumine
Flatulence
Decompression
Colon
Logistic Models
Odds Ratio
X-Rays
Databases
Confidence Intervals

Keywords

  • Gastrografin
  • Nonoperative management
  • Small bowel obstruction

ASJC Scopus subject areas

  • Surgery

Cite this

Mulder, M. B., Hernandez, M., Ray-Zack, M., Cullinane, D. C., Turay, D., Wydo, S., ... Yeh, D. D. (2019). A significant proportion of small bowel obstructions require >48 hours to resolve after gastrografin. Journal of Surgical Research, 233, 408-412. https://doi.org/10.1016/j.jss.2018.08.019

A significant proportion of small bowel obstructions require >48 hours to resolve after gastrografin. / Mulder, Michelle B.; Hernandez, Matthew; Ray-Zack, Mohamed; Cullinane, Daniel C.; Turay, David; Wydo, Salina; Zielinski, Martin; Yeh, D. Dante.

In: Journal of Surgical Research, Vol. 233, 01.01.2019, p. 408-412.

Research output: Contribution to journalArticle

Mulder, MB, Hernandez, M, Ray-Zack, M, Cullinane, DC, Turay, D, Wydo, S, Zielinski, M & Yeh, DD 2019, 'A significant proportion of small bowel obstructions require >48 hours to resolve after gastrografin', Journal of Surgical Research, vol. 233, pp. 408-412. https://doi.org/10.1016/j.jss.2018.08.019
Mulder, Michelle B. ; Hernandez, Matthew ; Ray-Zack, Mohamed ; Cullinane, Daniel C. ; Turay, David ; Wydo, Salina ; Zielinski, Martin ; Yeh, D. Dante. / A significant proportion of small bowel obstructions require >48 hours to resolve after gastrografin. In: Journal of Surgical Research. 2019 ; Vol. 233. pp. 408-412.
@article{1597531b0346408a8fdf4c6849ded753,
title = "A significant proportion of small bowel obstructions require >48 hours to resolve after gastrografin",
abstract = "Background: Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen. Methods: A post hoc analysis of an Eastern Association for the Surgery of Trauma multi-institutional SBO database was performed including only those receiving GG challenge. Successful nonoperative management (NOM) was defined as passage of flatus or nasogastric tube (NGT) removal. NOM was considered a failure if operative intervention was required. Multiple logistic regression was performed to identify predictors of delayed (>48 h) GG challenge effect and expressed as odds ratios with 95{\%} confidence intervals. Results: Of 286 patients receiving GG, 208 patients (73{\%}) were successfully managed nonoperatively. A total of 60 (29{\%}) NOM patients had NGT decompression for >48 h (n = 54) or required >48 h to pass flatus (n = 34), with some requiring both (n = 28). Prior abdominal operations and SBO admission were protective of delayed GG effect (0.411 [0.169-1.00], P < 0.05; 0.478 [0.240-0.952], P < 0.036). Conclusions: A significant proportion of patients at 48 h (29{\%}) “failed” the GG challenge as they had yet to pass flatus or still required NGT but were nonetheless successfully managed nonoperatively. Extending the GG challenge beyond 48 h may help avoid unnecessary operations. Level of evidence: Level II.",
keywords = "Gastrografin, Nonoperative management, Small bowel obstruction",
author = "Mulder, {Michelle B.} and Matthew Hernandez and Mohamed Ray-Zack and Cullinane, {Daniel C.} and David Turay and Salina Wydo and Martin Zielinski and Yeh, {D. Dante}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jss.2018.08.019",
language = "English (US)",
volume = "233",
pages = "408--412",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - A significant proportion of small bowel obstructions require >48 hours to resolve after gastrografin

AU - Mulder, Michelle B.

AU - Hernandez, Matthew

AU - Ray-Zack, Mohamed

AU - Cullinane, Daniel C.

AU - Turay, David

AU - Wydo, Salina

AU - Zielinski, Martin

AU - Yeh, D. Dante

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen. Methods: A post hoc analysis of an Eastern Association for the Surgery of Trauma multi-institutional SBO database was performed including only those receiving GG challenge. Successful nonoperative management (NOM) was defined as passage of flatus or nasogastric tube (NGT) removal. NOM was considered a failure if operative intervention was required. Multiple logistic regression was performed to identify predictors of delayed (>48 h) GG challenge effect and expressed as odds ratios with 95% confidence intervals. Results: Of 286 patients receiving GG, 208 patients (73%) were successfully managed nonoperatively. A total of 60 (29%) NOM patients had NGT decompression for >48 h (n = 54) or required >48 h to pass flatus (n = 34), with some requiring both (n = 28). Prior abdominal operations and SBO admission were protective of delayed GG effect (0.411 [0.169-1.00], P < 0.05; 0.478 [0.240-0.952], P < 0.036). Conclusions: A significant proportion of patients at 48 h (29%) “failed” the GG challenge as they had yet to pass flatus or still required NGT but were nonetheless successfully managed nonoperatively. Extending the GG challenge beyond 48 h may help avoid unnecessary operations. Level of evidence: Level II.

AB - Background: Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen. Methods: A post hoc analysis of an Eastern Association for the Surgery of Trauma multi-institutional SBO database was performed including only those receiving GG challenge. Successful nonoperative management (NOM) was defined as passage of flatus or nasogastric tube (NGT) removal. NOM was considered a failure if operative intervention was required. Multiple logistic regression was performed to identify predictors of delayed (>48 h) GG challenge effect and expressed as odds ratios with 95% confidence intervals. Results: Of 286 patients receiving GG, 208 patients (73%) were successfully managed nonoperatively. A total of 60 (29%) NOM patients had NGT decompression for >48 h (n = 54) or required >48 h to pass flatus (n = 34), with some requiring both (n = 28). Prior abdominal operations and SBO admission were protective of delayed GG effect (0.411 [0.169-1.00], P < 0.05; 0.478 [0.240-0.952], P < 0.036). Conclusions: A significant proportion of patients at 48 h (29%) “failed” the GG challenge as they had yet to pass flatus or still required NGT but were nonetheless successfully managed nonoperatively. Extending the GG challenge beyond 48 h may help avoid unnecessary operations. Level of evidence: Level II.

KW - Gastrografin

KW - Nonoperative management

KW - Small bowel obstruction

UR - http://www.scopus.com/inward/record.url?scp=85053451604&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053451604&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2018.08.019

DO - 10.1016/j.jss.2018.08.019

M3 - Article

VL - 233

SP - 408

EP - 412

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -