Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value

•Water-soluble contrast agent administration in adhesive small bowel obstruction reduce the need for surgery, length of stay, and time to resolution.•Water-soluble contrast agent administration in adhesive small bowel obstruction is a safe procedure.•Abdominal X-rays should be taken at least 8 hours after the administration of water-soluble contrast agent in order to better predict the resolution.

BackgroundAdhesive small bowel obstructions are the most common postoperative causes of hospitalization. Several studies investigated the diagnostic and therapeutic role of water-soluble contrast agent (WSCA) in predicting the need for surgery, but there is no consensus.MethodsA systematic review and meta-analysis was done of studies on diagnostic and therapeutic role of oral WSCA.ResultsWSCA had a sensitivity of 92% and a specificity of 93% in predicting resolution of obstruction without surgery; diagnostic accuracy increased significantly if abdominal X-rays were taken after 8 hours. The administration of oral WSCA reduced the need for surgery (odds ratio .55, P = .003), length of stay (weighted mean difference −2.18 days, P < .00001), and time to resolution (weighted mean difference −28.25 hours, P < .00001). No differences in terms of morbidity or mortality were recorded.ConclusionsThe administration of WSCA is accurate in predicting the need for surgery; the test should be taken after at least 8 hours from administration. WSCA is a proven safe and effective treatment, correlated with a significant reduction in the need for surgery and in the length of hospital stay.