Contrast Challenge Algorithms for Adhesive Small Bowel Obstructions Are Safe in Children: A Multi-Institutional Study

Infographic · Dec 2021 · 1 min read

In brief

Multi-institutional study of 82 children demonstrates water-soluble contrast challenge is safe (0% complications) and highly predictive for managing adhesive small bowel obstructions nonoperatively, with 100% sensitivity and 86% specificity. Results support contrast protocols to guide clinical decision-making and avoid unnecessary surgery in pediatric ASBO.

Water-soluble contrast challenge is safe in pediatric ASBO with 0% complication rate (95% CI: 0-3.6%) across 5 institutions.
Contrast challenge has 100% sensitivity and NPV for predicting need for surgery, reliably identifying operative candidates.
65% of children with ASBO receiving contrast challenge were successfully managed nonoperatively, avoiding surgery.
Contrast challenge provides objective data to guide clinical decision-making in pediatric ASBO management algorithms.
Multi-institutional validation supports incorporating contrast challenge into standard pediatric ASBO protocols.

Written by the GCMD Library team from the infographic.

The infographic uses a left-to-right flow design with gray and yellow color coding. On the left, icons illustrate adhesive bowel obstruction in children. The center shows a contrast study bottle and patient silhouette with digestive tract highlighted. A branching diagram splits outcomes into gray (non-progression) at 30% and yellow (progression) at 70%, with the yellow path leading to a 93% spontaneous resolution rate marked by a prohibition symbol indicating no surgery needed.

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.

The text in the image

CONTRAST CHALLENGE PREDICTS SPONTANEOUS RESOLUTION OF ADHESIVE BOWEL OBSTRUCTION IN CHILDREN | MULTICENTRIC, USA | RETROSPECTIVE | 2012-2020 | ADHESIVE BOWEL OBSTRUCTION | WITHOUT SIGNS OF COMPLICATION | n=82 | 30% | CONTRAST STUDY | 70% | NON PROGRESSION OF CONTRAST | PROGRESSION OF CONTRAST | SPONTANEOUS RESOLUTION | 93% | SEN 100% | SPE 86% | PPV 93% | NPV 100% | Rubalcava, NS. et al. Aug 2021 | DOI:10.1097/sla.0000000000005159 | Authors: Paula Aylwin, José Manuel Campos Varas | @anastopoietic_design

Read it at the source ↗