Evaluation of a water-soluble contrast protocol for small bowel obstruction: A southwestern surgical congress multicenter trial
Differentiation between SBO that will resolve with supportive measures and those requiring surgery remains challenging. WSC administration may be diagnostic and therapeutic. The purpose of this study was to evaluate use of a SBO protocol using WSC challenge. A protocol was implemented at five tertia...
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| Veröffentlicht in: | The American journal of surgery 2019-12, Vol.218 (6), p.1046-1051 |
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| creator | Moskowitz, Eliza E. McIntyre, Robert C. Burlew, Clay Cothren Helmkamp, Laura J. Peltz, Erik D. Coleman, Julia R. Kovar, Alexandra Truitt, Michael Agrawal, Vaidehi Onkendi, Edwin Dev, Rushabh Diaz, Jose J. Eaton, Barbara Campion, Eric M. |
| description | Differentiation between SBO that will resolve with supportive measures and those requiring surgery remains challenging. WSC administration may be diagnostic and therapeutic. The purpose of this study was to evaluate use of a SBO protocol using WSC challenge.
A protocol was implemented at five tertiary care centers. Demographics, prior surgical history, time to operation, complications, and LOS were analyzed.
283 patients were admitted with SBO; 13% underwent immediate laparotomy; these patients had a median LOS of 7.5 days. The remaining 245 were candidates for WSC challenge. Of those, 80% received contrast. 139 (71%) had contrast passage to the colon. LOS in these patients was 4 days. Sixty-five patients (29%) failed contrast passage within 24 h and underwent surgery. LOS was 9 days. 8% of patients in whom contrast passage was observed at 24 h nevertheless subsequently underwent surgery. 4% of patients who failed WSC challenge did not proceed to surgery.
Our multicenter trial revealed that implementation of a WSC protocol may facilitate early recognition of partial from complete obstruction.
•Water soluble contrast administration may be both diagnostic and therapeutic and can decrease time to surgery.•Patients undergoing surgery for small bowel obstruction were found to have a high rate of infectious complications.•Water soluble contrast administration aids in identifying which patients will require surgery for their small bowel obstruction. |
| doi_str_mv | 10.1016/j.amjsurg.2019.09.031 |
| format | Article |
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A protocol was implemented at five tertiary care centers. Demographics, prior surgical history, time to operation, complications, and LOS were analyzed.
283 patients were admitted with SBO; 13% underwent immediate laparotomy; these patients had a median LOS of 7.5 days. The remaining 245 were candidates for WSC challenge. Of those, 80% received contrast. 139 (71%) had contrast passage to the colon. LOS in these patients was 4 days. Sixty-five patients (29%) failed contrast passage within 24 h and underwent surgery. LOS was 9 days. 8% of patients in whom contrast passage was observed at 24 h nevertheless subsequently underwent surgery. 4% of patients who failed WSC challenge did not proceed to surgery.
Our multicenter trial revealed that implementation of a WSC protocol may facilitate early recognition of partial from complete obstruction.
•Water soluble contrast administration may be both diagnostic and therapeutic and can decrease time to surgery.•Patients undergoing surgery for small bowel obstruction were found to have a high rate of infectious complications.•Water soluble contrast administration aids in identifying which patients will require surgery for their small bowel obstruction.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2019.09.031</identifier><identifier>PMID: 31623878</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdomen ; Adult ; Colon ; Complications ; Contrast Media - administration & dosage ; Demographics ; Demography ; Diagnostic systems ; Diatrizoate Meglumine - administration & dosage ; Edema ; Evaluation ; Female ; Hospitals ; Humans ; Intestinal obstruction ; Intestinal Obstruction - diagnostic imaging ; Intestinal Obstruction - surgery ; Intestine, Small ; Male ; Middle Aged ; Mortality ; Pain ; Patients ; Retrospective Studies ; Small intestine ; Surgeons ; Surgery ; Tomography, X-Ray Computed</subject><ispartof>The American journal of surgery, 2019-12, Vol.218 (6), p.1046-1051</ispartof><rights>2019</rights><rights>Copyright © 2019. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Dec 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-7f724ab660f4db7a1839bd37d5d628bd8056f82e13f7c5cf5fb4fabd1b04b10e3</citedby><cites>FETCH-LOGICAL-c393t-7f724ab660f4db7a1839bd37d5d628bd8056f82e13f7c5cf5fb4fabd1b04b10e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002961019303794$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31623878$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moskowitz, Eliza E.</creatorcontrib><creatorcontrib>McIntyre, Robert C.</creatorcontrib><creatorcontrib>Burlew, Clay Cothren</creatorcontrib><creatorcontrib>Helmkamp, Laura J.</creatorcontrib><creatorcontrib>Peltz, Erik D.</creatorcontrib><creatorcontrib>Coleman, Julia R.</creatorcontrib><creatorcontrib>Kovar, Alexandra</creatorcontrib><creatorcontrib>Truitt, Michael</creatorcontrib><creatorcontrib>Agrawal, Vaidehi</creatorcontrib><creatorcontrib>Onkendi, Edwin</creatorcontrib><creatorcontrib>Dev, Rushabh</creatorcontrib><creatorcontrib>Diaz, Jose J.</creatorcontrib><creatorcontrib>Eaton, Barbara</creatorcontrib><creatorcontrib>Campion, Eric M.</creatorcontrib><title>Evaluation of a water-soluble contrast protocol for small bowel obstruction: A southwestern surgical congress multicenter trial</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Differentiation between SBO that will resolve with supportive measures and those requiring surgery remains challenging. WSC administration may be diagnostic and therapeutic. The purpose of this study was to evaluate use of a SBO protocol using WSC challenge.
A protocol was implemented at five tertiary care centers. Demographics, prior surgical history, time to operation, complications, and LOS were analyzed.
283 patients were admitted with SBO; 13% underwent immediate laparotomy; these patients had a median LOS of 7.5 days. The remaining 245 were candidates for WSC challenge. Of those, 80% received contrast. 139 (71%) had contrast passage to the colon. LOS in these patients was 4 days. Sixty-five patients (29%) failed contrast passage within 24 h and underwent surgery. LOS was 9 days. 8% of patients in whom contrast passage was observed at 24 h nevertheless subsequently underwent surgery. 4% of patients who failed WSC challenge did not proceed to surgery.
Our multicenter trial revealed that implementation of a WSC protocol may facilitate early recognition of partial from complete obstruction.
•Water soluble contrast administration may be both diagnostic and therapeutic and can decrease time to surgery.•Patients undergoing surgery for small bowel obstruction were found to have a high rate of infectious complications.•Water soluble contrast administration aids in identifying which patients will require surgery for their small bowel obstruction.</description><subject>Abdomen</subject><subject>Adult</subject><subject>Colon</subject><subject>Complications</subject><subject>Contrast Media - administration & dosage</subject><subject>Demographics</subject><subject>Demography</subject><subject>Diagnostic systems</subject><subject>Diatrizoate Meglumine - administration & dosage</subject><subject>Edema</subject><subject>Evaluation</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intestinal obstruction</subject><subject>Intestinal Obstruction - diagnostic imaging</subject><subject>Intestinal Obstruction - surgery</subject><subject>Intestine, Small</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pain</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Small intestine</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Tomography, X-Ray Computed</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU1rFTEUhoMo9lr9CUrAjZu55kxmMhk3Ukr9gIKbdh2STFIzZCY1H7105V83w726cFM4EEKe8-Y950XoLZA9EGAf571c5lTi3b4lMO5JLQrP0A74MDbAOX2OdoSQthkZkDP0KqW5XgE6-hKdUWAt5QPfod9XD9IXmV1YcbBY4oPMJjYp-KK8wTqsOcqU8X0MOejgsQ0Rp0V6j1U4GI-DSjkWvQl8whc4hZJ_HkyqIive7Dkt_SZzF01KeCk-O23W-oxzdNK_Ri-s9Mm8OZ3n6PbL1c3lt-b6x9fvlxfXjaYjzc1gh7aTijFiu0kNEjgd1USHqZ9Yy9XESc8sbw1QO-he296qzko1gSKdAmLoOfpw1K2D_CrVn1hc0sZ7uZpQkmgpGaDr2DhU9P1_6BxKXKu7SgGjvGcjrVR_pHQMKUVjxX10i4yPAojYEhKzOCUktoQEqUWh9r07qRe1mOlf199IKvD5CJi6jgdnokjamVWbyUWjs5iCe-KLP4fUqCA</recordid><startdate>201912</startdate><enddate>201912</enddate><creator>Moskowitz, Eliza E.</creator><creator>McIntyre, Robert C.</creator><creator>Burlew, Clay Cothren</creator><creator>Helmkamp, Laura J.</creator><creator>Peltz, Erik D.</creator><creator>Coleman, Julia R.</creator><creator>Kovar, Alexandra</creator><creator>Truitt, Michael</creator><creator>Agrawal, Vaidehi</creator><creator>Onkendi, Edwin</creator><creator>Dev, Rushabh</creator><creator>Diaz, Jose J.</creator><creator>Eaton, Barbara</creator><creator>Campion, Eric M.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201912</creationdate><title>Evaluation of a water-soluble contrast protocol for small bowel obstruction: A southwestern surgical congress multicenter trial</title><author>Moskowitz, Eliza E. ; McIntyre, Robert C. ; Burlew, Clay Cothren ; Helmkamp, Laura J. ; Peltz, Erik D. ; Coleman, Julia R. ; Kovar, Alexandra ; Truitt, Michael ; Agrawal, Vaidehi ; Onkendi, Edwin ; Dev, Rushabh ; Diaz, Jose J. ; Eaton, Barbara ; Campion, Eric M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-7f724ab660f4db7a1839bd37d5d628bd8056f82e13f7c5cf5fb4fabd1b04b10e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abdomen</topic><topic>Adult</topic><topic>Colon</topic><topic>Complications</topic><topic>Contrast Media - administration & dosage</topic><topic>Demographics</topic><topic>Demography</topic><topic>Diagnostic systems</topic><topic>Diatrizoate Meglumine - administration & dosage</topic><topic>Edema</topic><topic>Evaluation</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intestinal obstruction</topic><topic>Intestinal Obstruction - diagnostic imaging</topic><topic>Intestinal Obstruction - surgery</topic><topic>Intestine, Small</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pain</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Small intestine</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moskowitz, Eliza E.</creatorcontrib><creatorcontrib>McIntyre, Robert C.</creatorcontrib><creatorcontrib>Burlew, Clay Cothren</creatorcontrib><creatorcontrib>Helmkamp, Laura J.</creatorcontrib><creatorcontrib>Peltz, Erik D.</creatorcontrib><creatorcontrib>Coleman, Julia R.</creatorcontrib><creatorcontrib>Kovar, Alexandra</creatorcontrib><creatorcontrib>Truitt, Michael</creatorcontrib><creatorcontrib>Agrawal, Vaidehi</creatorcontrib><creatorcontrib>Onkendi, Edwin</creatorcontrib><creatorcontrib>Dev, Rushabh</creatorcontrib><creatorcontrib>Diaz, Jose J.</creatorcontrib><creatorcontrib>Eaton, Barbara</creatorcontrib><creatorcontrib>Campion, Eric M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moskowitz, Eliza E.</au><au>McIntyre, Robert C.</au><au>Burlew, Clay Cothren</au><au>Helmkamp, Laura J.</au><au>Peltz, Erik D.</au><au>Coleman, Julia R.</au><au>Kovar, Alexandra</au><au>Truitt, Michael</au><au>Agrawal, Vaidehi</au><au>Onkendi, Edwin</au><au>Dev, Rushabh</au><au>Diaz, Jose J.</au><au>Eaton, Barbara</au><au>Campion, Eric M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of a water-soluble contrast protocol for small bowel obstruction: A southwestern surgical congress multicenter trial</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2019-12</date><risdate>2019</risdate><volume>218</volume><issue>6</issue><spage>1046</spage><epage>1051</epage><pages>1046-1051</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Differentiation between SBO that will resolve with supportive measures and those requiring surgery remains challenging. WSC administration may be diagnostic and therapeutic. The purpose of this study was to evaluate use of a SBO protocol using WSC challenge.
A protocol was implemented at five tertiary care centers. Demographics, prior surgical history, time to operation, complications, and LOS were analyzed.
283 patients were admitted with SBO; 13% underwent immediate laparotomy; these patients had a median LOS of 7.5 days. The remaining 245 were candidates for WSC challenge. Of those, 80% received contrast. 139 (71%) had contrast passage to the colon. LOS in these patients was 4 days. Sixty-five patients (29%) failed contrast passage within 24 h and underwent surgery. LOS was 9 days. 8% of patients in whom contrast passage was observed at 24 h nevertheless subsequently underwent surgery. 4% of patients who failed WSC challenge did not proceed to surgery.
Our multicenter trial revealed that implementation of a WSC protocol may facilitate early recognition of partial from complete obstruction.
•Water soluble contrast administration may be both diagnostic and therapeutic and can decrease time to surgery.•Patients undergoing surgery for small bowel obstruction were found to have a high rate of infectious complications.•Water soluble contrast administration aids in identifying which patients will require surgery for their small bowel obstruction.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31623878</pmid><doi>10.1016/j.amjsurg.2019.09.031</doi><tpages>6</tpages></addata></record> |
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| ispartof | The American journal of surgery, 2019-12, Vol.218 (6), p.1046-1051 |
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| subjects | Abdomen Adult Colon Complications Contrast Media - administration & dosage Demographics Demography Diagnostic systems Diatrizoate Meglumine - administration & dosage Edema Evaluation Female Hospitals Humans Intestinal obstruction Intestinal Obstruction - diagnostic imaging Intestinal Obstruction - surgery Intestine, Small Male Middle Aged Mortality Pain Patients Retrospective Studies Small intestine Surgeons Surgery Tomography, X-Ray Computed |
| title | Evaluation of a water-soluble contrast protocol for small bowel obstruction: A southwestern surgical congress multicenter trial |
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