• Kyle D Klingbeil, James X Wu, Antonia Osuna-Garcia, and Edward H Livingston.
• Department of Surgery, UCLA School of Medicine, Los Angeles, CA.
• Ann. Surg. 2022 Dec 1; 276 (6): 981988981-988.

ObjectiveTo better understand the efficacy of water-soluble contrast (WSC) in the treatment of adhesive small bowel obstruction (SBO).BackgroundGuidelines recommend using WSC to treat adhesive SBO nonoperatively by acting as a cathartic agent. The evidence supporting this practice is mixed.MethodsA systematic review and meta-analysis of published articles describing the effect of WSC compared with control treatments was performed for the period of January 1, 1990 to November 1, 2021. Study quality was assessed using the Cochrane risk-of-bias and the Newcastle-Ottawa tools. The therapeutic effect of WSC was assessed by operative rates and hospital length of stay (HLOS) in nonsurgical patients.ResultsThe initial search yielded 4879 articles, of which, 28 were selected for full text review. We identified 11 eligible randomized controlled trials (RCTs) which included 817 patients and 9 observational studies of 3944 patients. HLOS in nonsurgical patients decreased by 1.95 days (95% confidence interval: 0.56-3.3) in the RCTs and could not be assessed in the observational studies. WSC did not significantly affect operative rates in the RCTs (19.8% vs. 21.4%) but did reduce rates in the observational studies (11% vs. 16%, risk ratio: 0.56, 95% confidence interval: 0.39-0.82).ConclusionWSC studies may reduce HLOS for patients who have SBO and do not require surgery. However, the current literature is heterogenous with considerable design limitations. High-quality RCTs are needed using standardized protocols to determine the full benefit of WSC for the management of SBO.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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