SBO ACTION: conservative Small Bowel Obstruction management in the Absence of standard ConTrast agents ON outcomes

Josephine Walshaw; Daniel Ashmore; Adam Peckham-Cooper; Matthew J. Lee; Raimundas Lunevičius; Adam Daniel Gerrard; Jay Roe Tan; R Nieuwoudt; Jacob Mewse; A Luesley; N Eardley; R Clifford; Lucia Sepesiova; Tim Wilson; Thomas C. Hall; Shoieb Mridha; Jessie Blackburn; Ajay Belgaumkar; Khaldoun Fozo; Sukanya Thavanesan; Oroog Ali; Alex McCulla; Ross Lilley; Chathura Munasinghe; Milad Tavakoli; Ademola Adeyeye; Amyn Haji; Ayinke Dosu; Panagiotis Kapsampelis; Ioannis Gerogiannis; Georgios Bointas; Negar Ghaffari; Shirley Chan; Keshav Jindal; Danny Lamdin; Devika Nair; Sita Kotecha; Ala Saab; Alex Wilkins; Annabelle Williams; Naomi Warner; Anamaria Schipor; Liam Martin; Ashuvini Mehendran; Marianne Hollyman; Mike Richardt; John Wayman; Hannah Dunlop; Ning Xuan Ho; Olivia Cory; Michael Okocha; Luke Williams; Michael El Boghdady; Hussayn Shinwari; Edward J Nevins; Kohei Yamada; Aya Musbahi; Tejinderjit Athwal; Alex Carney; Daisy Evans; Tomasz Galus; Victoria Gregory; Nicholas Newton; Andrew J. Daley

doi:10.1093/bjs/znaf104

May 31, 2025British journal of surgeryOpen Access

SBO ACTION: conservative Small Bowel Obstruction management in the Absence of standard ConTrast agents ON outcomes

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Key Points

Assess the clinical outcomes and therapeutic utility of water-soluble contrast agents during non-operative management of adhesional small bowel obstruction amid a national contrast shortage.
Multicentre prospective cohort study conducted across 19 UK NHS hospital trusts between April 1 and July 1, 2024.
Included 408 consecutive adults with CT-confirmed adhesional small bowel obstruction managed non-operatively for at least 24 hours.
Compared outcomes between patients undergoing water-soluble contrast challenge (n=254; 90.5% Gastrografin) and those managed without contrast (n=154).
Non-operative management resolved obstruction in 81.6% (333/408) of patients, achieving higher success without contrast challenge than with it (83.8% vs 73.2%, P=0.014).
Contrast administration was associated with higher operative rates (22.4% vs 11.7%, P=0.007; multivariable adjusted OR 2.41, 95% CI 1.29 to 4.76, P=0.008) and longer median time to operation (3.0 vs 1.0 days, P<0.001).
In-hospital mortality showed no significant difference with or without contrast (5.1% vs 5.8%, P=0.8), and radiographic presence of contrast in the colon showed 66.5% sensitivity and 56.1% specificity for obstruction resolution.

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Multicentre prospective cohort study demonstrates that water-soluble contrast use does not improve non-operative resolution in adhesional small bowel obstruction, suggesting limited therapeutic...

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Walshaw et al. (2025) studied this question.

synapsesocial.com/papers/6aa9e03971e43eb1ac5579fd https://doi.org/10.1093/bjs/znaf104

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SBO ACTION: conservative Small Bowel Obstruction management in the Absence of standard ConTrast agents ON outcomes

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SBO ACTION: conservative Small Bowel Obstruction management in the Absence of standard ConTrast agents ON outcomes

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