M. D. Ray-Zack1, O. Alnachoukati2, J. Dunn2, S. Godin2, B. Smoot2, M. Zielinski1 1Mayo Clinic,Rochester, MN, USA 2UCHealth North Medical Center of the Rockies,Loveland, CO, USA
Introduction:
Gastrografin (GG) is a commonly administered contrast to evaluate and treat adhesive small bowel obstruction (SBO). Resolution of SBO can be confirmed by identifying GG contrast in the colon either via a single abdominal x-ray (AXR), i.e. GG Challenge (GGC); or via a series of AXRs until the contrast reaches the colon, i.e. small bowel follow-through (SBFT). In this study, we aimed to determine the optimal time of the first AXR following GG administration for SBFT.
Methods:
A retrospective review included patients with SBO undergoing SBFT at one institution vs. GGC at another institution from Mar 2015 –Jan 2018. Patient characteristics and medical history were recorded to calculate Charlson Age-Comorbidity Index (CACI). SBO severity was graded according to the American Association for the Surgery of Trauma imaging criteria. The primary outcome was the time of noting GG contrast in the colon on AXR. Additional outcomes following GG administration were also analyzed. Time intervals were described as median hours/days [interquartile range]. Multivariable regression model controlled for patients’ age, sex, BMI, CACI, previous SBO admissions, abdominal surgeries, and SBO severity grade.
Results:
A total of 255 patients were included: SBFT= 128; GGC=127. No significant difference in patients’ age, sex, prior SBO admissions, or SBO severity grade was noted (Table 1). SBO resolved following GG administration for 103 (80.5%) of SBFT patients, and 100 (78.7%) of GGC patients. GG in colon was confirmed on AXR earlier among SBFT patients compared to GGC patients: 4 [2-6] vs. 8.5 [8-9] hrs, p <0.001. However, SBFT patients underwent imaging more often: 3 [2-4] vs. 1 [1-1] AXRs, p <0.001. Time from hospital admission to operative exploration for SBFT was not significantly different: 34 [20-94] vs. 47 [21-105] hrs, p=0.70. SBFT patients were not significantly different from GGC patients in terms of GG aspiration: 0.8% vs. 1.6%, p =0.3127; time to soft diet toleration: 2 [1-4] vs. 1 [1-3] days, p =0.05; and hospital length of stay: 2 [3-5] vs. 2 [1-5] days, p=0.10.
Conclusion:
SBFT and GGC are effective approaches for managing SBO. Earlier imaging confirmation of SBO resolution was not associated with earlier operative exploration or shorter hospital stay. Practice guidelines to confirm GG in colon at 4 hrs & 8 hrs AXRs may be more efficient for non-operative SBO management.
