V. Nwigwe1, F. Wang2, K. Fischkoff1 1Columbia University College Of Physicians And Surgeons, Surgery, New York, NY, USA 2University Of Washington, Surgery, Seattle, WA, USA
Introduction: In patients with adhesive small bowel obstructions (aSBO), gastrografin challenge has been described as diagnostic (identifying those likely to fail non-operative management) and therapeutic (accelerating non-operative resolution of the obstruction). We review the effectiveness of standardized gastrografin challenge among patients with aSBO at our institution.
Methods: We implemented a protocol for the management of aSBO in accordance with evidence-based best practices described in the literature. We reviewed all patients admitted with aSBO eligible for non-operative management at Columbia University Irving Medical Center for six months before and six months after implementation of the protocol. The primary outcome was length of stay. Secondary outcomes included time between nasogastric tube (NGT) placement and removal, time to resumption of diet, and failure of non-operative management.
Results: We compared the 96 pre-intervention patients to 72 post-intervention patients. 62 of 72 (86%) patients in the post-intervention period underwent a gastrografin challenge. Patient demographics were similar in both groups. Length of stay was 4 days [95% CI 3.0-5.0] and 3.6 days [95% CI 2.4-4.7], time to NGT removal was 1.3 days [95% CI 0.8-1.8] and 2.3 days [95% CI 1.8-2.9], time to resumption of diet was 2.1 days [95% CI 1.6-2.6] and 2.0 days [95%CI 1.5-2.5], and percentage of non-op management failure was 15% [95% CI 9%-23%] and 13% [95% CI 7%-22%], in the pre- and post-intervention groups, respectively.
Conclusion: Incorporation of a standardized gastrografin challenge into an adhesive small bowel obstruction algorithm did not improve length of stay or success of non-operative management.
