Water-soluble contrast agents in adhesional small bowel obstruction: meta-analysis and PRECIS-2 assessment of trials.

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2025-05-07 DOI:10.1093/bjsopen/zraf049
Matthew Gowell, Daniel M Baker, Greta McLachlan, David N Naumann, Adam Peckham-Cooper, Neil J Smart, Matthew J Lee
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Abstract

Background: Adhesional small bowel obstruction is a common presentation to acute general surgical services. Initial management is typically conservative and includes the use of water-soluble contrast agents. Current trials assessing water-soluble contrast agents are limited by sample size and demonstrate contrasting results. The aim of this review was to systematically appraise the use of water-soluble contrast agents in adhesional small bowel obstruction.

Methods: This systematic review and meta-analysis was registered with PROSPERO (CRD42024573136) and conducted in line with PRISMA guidelines. Searches of Medline, Embase and Central databases were undertaken to include randomized clinical trials reporting the use of water-soluble contrast agents in adhesional small bowel obstruction. Searches were last updated on 26 July 2024. The primary outcome was the need for operative intervention. Secondary outcomes included the rate of intestinal ischaemia, the need for bowel resection, and mortality. A random-effects meta-analysis was conducted for outcomes reported in three or more studies. Risk of bias was assessed using the Cochrane Risk-of-Bias tool, and trial methods were appraised using the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) tool.

Results: In all, 11 randomized controlled trials were included with a median sample size of 88 (range 26-242), nine of which were single-centre studies; only one study used computed tomography imaging to diagnoses adhesional small bowel obstruction. Meta-analysis revealed no significant difference in operative intervention (odds ratio 0.63, 95% confidence interval 0.39 to 1.01; P = 0.053), small bowel ischaemia, small bowel resection, or mortality. Risk of bias raised concerns in several domains. PRECIS-2 assessment showed trials were pragmatic rather than explanatory designs.

Conclusion: This review does not support the use of therapeutic water-soluble contrast agents in adhesional small bowel obstruction. Further adequately powered trials are needed. Standardization of diagnostic modality and consideration of explanatory designs should be considered.

水溶性对比剂在粘连性小肠阻塞中的应用:meta分析和PRECIS-2试验评估。
背景:粘连性小肠梗阻是普通外科急症的常见表现。最初的治疗通常是保守的,包括使用水溶性造影剂。目前评估水溶性造影剂的试验受到样本量的限制,结果也不尽相同。本综述的目的是系统地评价水溶性对比剂在粘连性小肠阻塞中的应用。方法:本系统评价和荟萃分析在PROSPERO注册(CRD42024573136),并按照PRISMA指南进行。检索Medline、Embase和Central数据库,纳入报告在粘连性小肠梗阻中使用水溶性对比剂的随机临床试验。最后一次更新是在2024年7月26日。主要结果是是否需要手术干预。次要结局包括肠缺血发生率、肠切除术的必要性和死亡率。对三个或三个以上的研究报告的结果进行随机效应荟萃分析。使用Cochrane风险偏倚工具评估偏倚风险,使用PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2)工具评估试验方法。结果:共纳入11项随机对照试验,中位样本量为88例(范围26-242),其中9项为单中心研究;只有一项研究使用计算机断层成像诊断粘连性小肠梗阻。meta分析显示手术干预无显著差异(优势比0.63,95%可信区间0.39 ~ 1.01;P = 0.053)、小肠缺血、小肠切除或死亡率。偏见风险在几个领域引起了关注。PRECIS-2评估显示,试验是务实的,而不是解释性的设计。结论:本综述不支持使用水溶性对比剂治疗粘连性小肠阻塞。需要进一步的有充分动力的试验。应考虑诊断方式的标准化和解释设计的考虑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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