Contrast Challenge Algorithms for Adhesive Small Bowel Obstructions Are Safe in Children: A Multi-Institutional Study
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · Oct 2021 · 1 min read
In brief
In brief
This multi-institutional study of 82 pediatric patients demonstrates that water-soluble contrast challenge is safe (0% complication rate) and highly predictive in managing adhesive small bowel obstructions, with 100% sensitivity and 86% specificity for identifying which children require surgery versus nonoperative management.
Written by the GCMD Library team from the article.
Objective: The purpose of this study was to evaluate the safety of a water-soluble contrast challenge as part of a nonoperative management algorithm in children with an adhesive small bowel obstruction (ASBO).
Background: Predicting which children will successfully resolve their ASBO with non-operative management at the time of admission remains difficult. Additionally, the safety of a water-soluble contrast challenge for children with ASBO has not been established in the literature.
Methods: A retrospective review was performed of patients who underwent non-operative management for an ASBO and received a contrast challenge across 5 children's hospitals between 2012 and 2020. Safety was assessed by comparing the complication rate associated with a contrast challenge against a pre-specified maximum acceptable level of 5%. Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values of a contrast challenge to identify successful nonoperative management were calculated.
Results: Of 82 children who received a contrast challenge, 65% were successfully managed nonoperatively. The most common surgical indications were failure of the contrast challenge or failure to progress after initially passing the contrast challenge. There were no complications related to contrast administration (0%; 95% confidence interval: 0-3.6%, P = 0.03). The contrast challenge was highly reliable in determining which patients would require surgery and which could be successfully managed non-operatively (sensitivity 100%, specificity 86%, NPV 100%, PPV 93%).
Conclusion: A contrast challenge is safe in children with ASBO and has a high predictive value to assist in clinical decision-making.
DOI: 10.1097/SLA.0000000000005159