SP2.06 A systematic review, meta-analysis, and PRECIS-2 assessment of trials of Water-Soluble Contrast Agents in Adhesional Small Bowel Obstruction

Aims Current trials assessing water soluble contrast agents (WSCAs) demonstrate contrasting results. The aim of this review was to systematically appraise the use of WSCAs in adhesional small bowel obstruction (aSBO). Methods This systematic review and meta-analysis was registered on PROSPERO (CRD42024573136) and conducted in line with PRISMA guidelines. Searches of Medline, Embase and Central databases were undertaken to include randomised controlled trials (RCTs) reporting use of WSCA in aSBO. Primary outcome was need for operative intervention. Secondary outcomes include rate of intestinal ischaemia, need for bowel resection and mortality. Random effects meta-analysis was conducted for outcomes reported in three or more studies. Risk of bias was assessed using Cochrane Risk of Bias Tool, and trial methods were appraised using PRECIS-2. Results A total of 11 RCTs were included with a median sample size of 88 (range 27-242), nine of which were single-centre, and only one study used CT imaging to diagnoses aSBO. Meta-analysis revealed no significant difference in operative intervention (OR 0.63 (95% CI 0.39-1.01) p = 0.053), or small bowel ischaemia (OR 0.41 (95% CI 0.11-1.51), p=0.18), small bowel resection (OR 1.24 (95% CI 0.68-2.27), p = 0.48)), or mortality (OR 1.27 (95% CI 0.47-3.23), p=0.67). Risk of bias raised concerns in several domains. PRECIS-2 assessment showed trials were pragmatic rather than explanatory designs. Discussion Available evidence in the literature does not support use of WSCA in aSBO. Further adequately-powered trials are needed. Standardisation of diagnostic modality, and consideration of explanatory designs should be considered