Diagnostic and Therapeutic Use of Water-Soluble Oral Contrast in Small Bowel Obstruction: Systematic Review and Meta-Analysis

Abstract Introduction: Small bowel obstruction is one of the most common surgical conditions in the United Kingdom. While patients with strangulation are managed operatively, the majority of patients who present with uncomplicated small bowel obstruction (SBO) are managed non-operatively. However, there is no established method for reliably predicting the need for surgery. Water-soluble oral contrast (WSOC) is believed to predict this phenomenon. In addition, it is believed that WSOC has a therapeutic effect in patients with SBO. Therefore, this meta-analysis assessed the diagnostic and therapeutic effects of WSOC in patients with SBO. Materials and Methods: The Medline, Embase, PubMed, and Cochrane databases were searched systematically. The outcome of the diagnostic arm was to predict the need for surgery by providing WSOC. This was achieved by calculating the cumulative sensitivity, specificity, positive and negative predictive values, and likelihood ratios. The primary outcome of the therapeutic arm was the ability of WSOC to reduce the need for surgery. The duration of hospital stay, time taken to resolve SBO, complications, and mortality were the secondary outcomes. For the latter, the weighted odds ratios (OR) and weighted mean differences were calculated. Results: A total of 15 prospective studies and 12 randomized clinical trials were included in the diagnostic and therapeutic arms, respectively. Siting of contrast in the colon within 4–24 h on an X-ray had a sensitivity of 95.04% and a specificity of 97.05 in the resolution of SBO. Treatment with WSOC was effective in reducing the need for surgery (OR: 0.61, P = 0.01). Conclusion: WSOC predicts the need for surgery in patients with SBO. Additionally, it reduces the need for surgery.