Water soluble contrast administration in the management of pediatric adhesive small bowel obstruction: A systematic review and meta-analysis
Document Type
Review Article
Department
Paediatric Surgery
Abstract
Objective: Water soluble contrast administration (WSCA) is increasingly being adopted as part of non-operative management (NOM) for adhesive small bowel obstruction (ASBO) in children. We undertook a systematic review and meta-analysis to characterize reported WSCA-based NOM protocols and evaluate their diagnostic and therapeutic efficacy in pediatric ASBO.
Methods: A systematic review of four research repositories was conducted in accordance with the PRISMA standards. Two reviewers screened relevant articles for inclusion, with disputes mediated by a third reviewer. Appraisal of risk of bias and certainty of evidence was conducted using the Cochrane ROBINS-I tool and the GRADE approach respectively.
Results: Of the 110 unique studies screened, 7 studies reporting 402 cases of pediatric ASBO met criteria. WSCA protocols varied between included studies. Three studies reported test characteristics of WSCA as a means to evaluate risk of progression to surgical intervention, with a pooled sensitivity and specificity of 98.9 % and 83.1 % respectively. Regarding therapeutic benefit, three studies compared progression to surgical intervention between children receiving WSCA-based NOM versus those receiving standard NOM. There was no difference in progression to surgical intervention between the two groups on pooled analysis (pooled OR = 0.66, 95 % CI = 0.11-3.96, I2 = 38 %). There were no major WSCA-related complications, including aspiration, anaphylaxis or renal failure, reported in any studies.
Conclusion: There is limited evidence to suggest that WSCA-based NOM is associated with reduced progression to surgical intervention. However, given the low risk of complications or adverse events, WSCA may have a role in standardizing care pathways for children with ASBO.
Type of study: Systematic review and meta-analysis.
Level of evidence: Level II evidence (systematic review of non-randomized studies).
Publication (Name of Journal)
Journal of Pediatric Surgery
DOI
10.1016/j.jpedsurg.2025.162465
Recommended Citation
Thobani, H.,
Khan, M. O.,
Minhas, A.,
Fatimi, S.,
Khan, R.,
Tirrell, T. F.,
Sylvester, K. G.,
Islam, S.,
Khan, F. A.
(2025). Water soluble contrast administration in the management of pediatric adhesive small bowel obstruction: A systematic review and meta-analysis. Journal of Pediatric Surgery, 60(10).
Available at:
https://ecommons.aku.edu/pakistan_fhs_mc_surg_paediatr/208
Comments
Pagination are not provided by the author/publisher.