1 results for Abbas, S

  • Meta-analaysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction

    Abbas, S; Bissett, Ian; Parry, Bryan (2007)

    Journal article
    The University of Auckland Library

    Background: Adhesions are the leading cause of small bowel obstruction. Identi???cation of patients who require surgery is dif???cult. This review analyses the role of Gastrogra???n??? as a diagnostic and therapeutic agent in the management of adhesive small bowel obstruction. Methods: A systematic search of Medline, Embase and Cochrane databases was performed to identify studies of the use of Gastrogra???n??? in adhesive small bowel obstruction. Studies that addressed the diagnostic role of water-soluble contrast agent were appraised, and data presented as sensitivity, speci???city, and positive and negative likelihood ratios. Results were pooled and a summary receiver???operator characteristic (ROC) curve was constructed. A meta-analysis of the data from six therapeutic studies was performed using the Mantel???Haenszel test and both ???xed- and random-effect models. Results: The appearance of water-soluble contrast agent in the colon on an abdominal radiograph within 24 h of its administration predicted resolution of obstruction with a pooled sensitivity of 97 per cent and speci???city of 96 per cent. The area under the summary ROC curve was 0??98. Water-soluble contrast agent did not reduce the need for surgical intervention (odds ratio 0??81, P = 0??300), but it did reduce the length of hospital stay for patients who did not require surgery compared with placebo (weighted mean difference ???1??84 days; P < 0??001). Conclusion: Published data strongly support the use of water-soluble contrast medium as a predictive test for non-operative resolution of adhesive small bowel obstruction. Although Gastrogra???n??? does not reduce the need for operation, it appears to shorten the hospital stay for those who do not require surgery

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