How useful is methylglucamine diatrizoate solution in patients with small-bowel obstruction?

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Abstract

BACKGROUND

Small-bowel obstruction (SBO) is common. Methylglucamine diatrizoate (Gastrografin®; Schering, Berlin, Germany) solution has been shown to resolve SBO effectively without operative intervention; however, its efficacy and safety in elderly patients is not clear.

OBJECTIVES

To determine the efficacy and safety of methylglucamine diatrizoate combined with octreotide in elderly patients with adhesive SBO.

DESIGN AND INTERVENTION

This prospective, randomized trial included patients ≥65 years old admitted to hospital with suspected SBO and who had undergone an intra-abdominal operation ≥4 months ago. SBO was diagnosed by abdominal pain, abnormal bowel sounds, distension, vomiting, and dilated small-bowel loops. Exclusion criteria included suspected tumor recurrence, strangulation, intestinal vascular disorder, peritonitis, colectomy, and intestinal obstruction that showed signs of resolution. Patients were randomly allocated to receive conservative treatment (control group) or treatment with methylglucamine diatrizoate plus octreotide (contrast group). A nasogastric tube was inserted in all patients. Pain was assessed before tube placement and then daily thereafter for 3 days with a scale (0 = none, 1 = slight, 2 = a lot, or 3 = awful). Daily radiographic examination was performed until resolution of obstruction, defined by passing stool or gas. Contrast group patients received a single 100 ml dose of methylglucamine diatrizoate and then 0.25 μg octreotide every 12 h. Laparotomy was performed if strangulation occurred or the obstruction did not resolve within 72 h. Surgeons were blinded to previous treatments.

OUTCOME MEASURES

The main outcome measures were pain, operative intervention, postoperative complications, nasogastric drainage, and duration of hospitalization.

RESULTS

In total, 162 patients (median age 72 years [range 65-100 years]) were included; 82 were in the control group. Resolution of the obstruction occurred in 74.3% and 91.3% of patients in the control and contrast groups, respectively. Hospital stay was shorter in the contrast group than in the control group (4 days [range 1-11 days] vs 7 days [range 2-12 days]; P<0.0001). Pain scores were lower on day 1 and 2 in the contrast group than in the control group (day 1: 1.20±0.40 vs 2.94±0.24; P<0.0001 and day 2: 0.33±0.55 vs 1.89±0.31; P<0.0001). Less nasogastric drainage was needed on days 2 and 3 in the contrast group than in the control group (day 2: 651.5±229.7 ml vs 964±301.8 ml; P<0.0001 and day 3: 381.6±163.4 ml vs 797.2 ±193.3 ml; P<0.0001). Fewer laparotomies and postoperative morbidities occurred in the contrast group than in the control group (7 vs 21; P = 0.005 and 0 vs 10; P = 0.03, respectively). In patients who did not undergo operative intervention, an earlier first oral intake, earlier passage of stool gas, and shorter duration of nasogastric tube placement were more common than in patients who underwent operative intervention (82.4±22.6 h vs 118.1±28.8 h; 68.2±19.1 h vs 85.9±17.5 h; and 90.5±23.8 h vs 144.8±29.1 h; P<0.0001 for all comparisons).

CONCLUSION

Methylglucamine diatrizoate with octreotide is safe and effective for use in elderly patients with SBO.

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