Oral water soluble contrast for malignant bowel obstruction.

Syrmis, W; Richard, R; Jenkins-Marsh, S; Chia, SC; Good, P

Oral water soluble contrast for malignant bowel obstruction.

Syrmis, W Richard, R Jenkins-Marsh, S Chia, SC Good, P

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Publisher:: Wiley
Publication Type:: Journal Article
Citation:: Cochrane Database Syst Rev, 2018, 3, (3), pp. CD012014
Issue Date:: 2018-03-07

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Field	Value	Language
dc.contributor.author	Syrmis, W
dc.contributor.author	Richard, R
dc.contributor.author	Jenkins-Marsh, S
dc.contributor.author	Chia, SC
dc.contributor.author	Good, P https://orcid.org/0000-0002-8198-0375
dc.date.accessioned	2022-09-12T04:40:21Z
dc.date.available	2022-09-12T04:40:21Z
dc.date.issued	2018-03-07
dc.identifier.citation	Cochrane Database Syst Rev, 2018, 3, (3), pp. CD012014
dc.identifier.issn	1469-493X
dc.identifier.issn	1469-493X
dc.identifier.uri	http://hdl.handle.net/10453/161755
dc.description.abstract	BACKGROUND: Malignant bowel obstruction (MBO) is a common problem in patients with intra-abdominal cancer. Oral water soluble contrast (OWSC) has been shown to be useful in the management of adhesive small bowel obstruction in identifying patients who will recover with conservative management alone and also in reducing the length of hospital stay. It is not clear whether the benefits of OWSC in adhesive small bowel obstruction are also seen in patients with MBO. OBJECTIVES: To determine the reliability of OWSC media and follow-up abdominal radiographs in predicting the success of conservative treatment in resolving inoperable MBO with conservative management.To determine the efficacy and safety of OWSC media in reducing the duration of obstruction and reducing hospital stay in people with MBO. SEARCH METHODS: We identified studies from searching Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in Process, Embase, CINAHL, Science Citation Index (Web of Science) and Conference Proceedings Citation Index - Science (Web of Science). We also searched registries of clinical trials and the CareSearch Grey Literature database. The date of the search was the 6 June 2017. SELECTION CRITERIA: Randomised controlled trials (RCTs), or prospective controlled studies, that evaluated the diagnostic potential of OWSC in predicting which malignant bowel obstructions will resolve with conservative treatment.RCTs, or prospective controlled studies, that assessed the therapeutic potential of OWSC in managing MBO at any level compared with placebo, no intervention or usual treatment or supportive care. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We assessed risk of bias and assessed the evidence using GRADE and created a 'Summary of findings' table. MAIN RESULTS: We found only one RCT meeting the selection criteria for the second objective (therapeutic potential) of this review. This study recruited nine participants. It compared the use of gastrografin versus placebo in adult patients with MBO with no indication for further intervention (surgery, endoscopy) apart from standardised conservative management.The overall risk of bias for the study was high due to issues with low numbers of participants, selective reporting of outcomes and a high attrition rate for the intervention arm.Primary outcomesThe included trial was a pilot study whose primary outcome was to test the feasibility for a large study. The authors reported specifically on the number of patients screened, the number recruited and reasons for exclusion; this was not the focus of our review.Due to the low number of participants, the authors of the study decided not to report on our primary outcome of assessing the ability of OWSC to predict the likelihood of malignant small bowel obstruction resolving with conservative treatment alone (diagnostic effect). It also did not report on our primary outcome of rate of resolution of MBO in patients receiving OWSC compared with those not receiving it (therapeutic effect).The study reported that no issues regarding safety or tolerability of either gastrografin or placebo were identified. The overall quality of the evidence for the incidence of adverse events with OWSC was very low, downgraded twice for serious limitations to study quality (high risk of selective reporting and attrition bias) and downgraded once for imprecision (sparse data).Secondary outcomesThe study planned to report on this review's secondary outcome measures of length of hospital stay and time from administration of OWSC to resolution of MBO. However the authors of the study decided not to do so due to the low numbers of patients recruited. The study did not report on our secondary outcome measure of survival times from onset of inoperable MBO until death. AUTHORS' CONCLUSIONS: There is insufficient evidence from RCTs to determine the place of OWSC in predicting which patients with inoperable MBO will respond with conservative treatment alone. There is also insufficient evidence from RCTs to determine the therapeutic effects and safety of OWSC in patients with malignant small bowel obstruction.
dc.format	Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	Cochrane Database Syst Rev
dc.relation.isbasedon	10.1002/14651858.CD012014.pub2
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences
dc.subject.classification	General & Internal Medicine
dc.subject.mesh	Abdominal Neoplasms
dc.subject.mesh	Administration, Oral
dc.subject.mesh	Adult
dc.subject.mesh	Conservative Treatment
dc.subject.mesh	Contrast Media
dc.subject.mesh	Diatrizoate Meglumine
dc.subject.mesh	Feasibility Studies
dc.subject.mesh	Humans
dc.subject.mesh	Intestinal Obstruction
dc.subject.mesh	Length of Stay
dc.subject.mesh	Pilot Projects
dc.subject.mesh	Humans
dc.subject.mesh	Abdominal Neoplasms
dc.subject.mesh	Intestinal Obstruction
dc.subject.mesh	Diatrizoate Meglumine
dc.subject.mesh	Contrast Media
dc.subject.mesh	Length of Stay
dc.subject.mesh	Administration, Oral
dc.subject.mesh	Feasibility Studies
dc.subject.mesh	Pilot Projects
dc.subject.mesh	Adult
dc.subject.mesh	Conservative Treatment
dc.title	Oral water soluble contrast for malignant bowel obstruction.
dc.type	Journal Article
utslib.citation.volume	3
utslib.location.activity	England
utslib.for	11 Medical and Health Sciences
utslib.for	17 Psychology and Cognitive Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access	*
dc.date.updated	2022-09-12T04:40:20Z
pubs.issue	3
pubs.publication-status	Published online
pubs.volume	3
utslib.citation.issue	3

Abstract:

BACKGROUND: Malignant bowel obstruction (MBO) is a common problem in patients with intra-abdominal cancer. Oral water soluble contrast (OWSC) has been shown to be useful in the management of adhesive small bowel obstruction in identifying patients who will recover with conservative management alone and also in reducing the length of hospital stay. It is not clear whether the benefits of OWSC in adhesive small bowel obstruction are also seen in patients with MBO. OBJECTIVES: To determine the reliability of OWSC media and follow-up abdominal radiographs in predicting the success of conservative treatment in resolving inoperable MBO with conservative management.To determine the efficacy and safety of OWSC media in reducing the duration of obstruction and reducing hospital stay in people with MBO. SEARCH METHODS: We identified studies from searching Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in Process, Embase, CINAHL, Science Citation Index (Web of Science) and Conference Proceedings Citation Index - Science (Web of Science). We also searched registries of clinical trials and the CareSearch Grey Literature database. The date of the search was the 6 June 2017. SELECTION CRITERIA: Randomised controlled trials (RCTs), or prospective controlled studies, that evaluated the diagnostic potential of OWSC in predicting which malignant bowel obstructions will resolve with conservative treatment.RCTs, or prospective controlled studies, that assessed the therapeutic potential of OWSC in managing MBO at any level compared with placebo, no intervention or usual treatment or supportive care. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We assessed risk of bias and assessed the evidence using GRADE and created a 'Summary of findings' table. MAIN RESULTS: We found only one RCT meeting the selection criteria for the second objective (therapeutic potential) of this review. This study recruited nine participants. It compared the use of gastrografin versus placebo in adult patients with MBO with no indication for further intervention (surgery, endoscopy) apart from standardised conservative management.The overall risk of bias for the study was high due to issues with low numbers of participants, selective reporting of outcomes and a high attrition rate for the intervention arm.Primary outcomesThe included trial was a pilot study whose primary outcome was to test the feasibility for a large study. The authors reported specifically on the number of patients screened, the number recruited and reasons for exclusion; this was not the focus of our review.Due to the low number of participants, the authors of the study decided not to report on our primary outcome of assessing the ability of OWSC to predict the likelihood of malignant small bowel obstruction resolving with conservative treatment alone (diagnostic effect). It also did not report on our primary outcome of rate of resolution of MBO in patients receiving OWSC compared with those not receiving it (therapeutic effect).The study reported that no issues regarding safety or tolerability of either gastrografin or placebo were identified. The overall quality of the evidence for the incidence of adverse events with OWSC was very low, downgraded twice for serious limitations to study quality (high risk of selective reporting and attrition bias) and downgraded once for imprecision (sparse data).Secondary outcomesThe study planned to report on this review's secondary outcome measures of length of hospital stay and time from administration of OWSC to resolution of MBO. However the authors of the study decided not to do so due to the low numbers of patients recruited. The study did not report on our secondary outcome measure of survival times from onset of inoperable MBO until death. AUTHORS' CONCLUSIONS: There is insufficient evidence from RCTs to determine the place of OWSC in predicting which patients with inoperable MBO will respond with conservative treatment alone. There is also insufficient evidence from RCTs to determine the therapeutic effects and safety of OWSC in patients with malignant small bowel obstruction.

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http://hdl.handle.net/10453/161755