1192 Role of Gastrograffin Enema in Loop Ileostomy Closure Preparative Assessment: A Retrospective Study

Aim This study aims to ascertain the role of gastrograffin enema in assessing anastomotic failures, stricture or leaks, in primary loop ileostomy patients with time-to-closure duration longer than 90 days. Method A retrospective analysis of ileostomy closure in a district hospital within 2 years (August 2021 to August 2023) with the time-to-closure duration exceeding 90 days from primary ileostomy. Gastrograffin enema and flexible sigmoidoscopy performance and findings will be identified to assess their role in pre-closure anastomotic failure detection. Results 39 patients were identified, of which 24 (61.5%) had gastrograffin enema before closure and only one patient (4.2%) was found to have an anastomotic leak in the gastrograffin study but with a subsequent normal study. The remainder had normal findings with no strictures reported from any of the gastrograffin studies. 28 patients (71.7%) in total underwent flexible sigmoidoscopy, of which 21 of them (53.8%) had dual study (gastrograffin enema and flexible sigmoidoscopy). 11 sigmoidoscopy findings (39.2%) in total were reported abnormal of which 3 were strictures (10.7%). 2 of the stricture findings had the dual study but were not initially picked up from the gastrograffin enema, while the remainder had no previous enema (p=0.0014). Conclusions The sensitivity of gastrograffin for anastomotic stricture was poor in patients with extended time-to-closure duration but was useful in anastomotic leak detection. This raises the question of the safe role of routine gastrograffin as an independent study to specifically detect strictures as opposed to a dual study in patients with absent clinical suspicion of anastomotic failure, regardless of duration.