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Utility of Enteral Contrast Protocols in Pediatric Adhesive Small Bowel Obstruction: A Prospective Multicenter
Shannon N Acker1,2, Romeo Ignacio3, Katie W Russell4
1Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
Insights
Enteral contrast challenges did not reduce surgery rates or hospitalization for pediatric adhesive small bowel obstruction (ASBO). Further research is needed to clarify the role of contrast in managing this condition in children.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Radiology
- Abdominal Imaging
Background:
- Enteral contrast protocols in adults with adhesive small bowel obstruction (ASBO) are linked to reduced surgery and shorter hospital stays.
- Limited pediatric-specific data exist regarding the efficacy of these protocols.
Purpose of the Study:
- To evaluate the effectiveness of enteral contrast-based protocols in diagnosing and managing pediatric adhesive small bowel obstruction (ASBO).
Main Methods:
- A prospective observational study was conducted across 9 children's hospitals from October 2020 to December 2022.
- Included were 136 children (aged 1-20 years) with ASBO undergoing nonoperative management.
- Children were compared based on whether they received an enteral contrast challenge.
Main Results:
- No significant difference in operative intervention rates between the contrast (36.9%) and no-contrast (34.6%) groups (P=0.93).
- Nonoperative management success was similar (64%), with no differences in length of stay or readmission rates.
- Among those requiring surgery, contrast administration did not affect time to surgery or small bowel resection rates.
Conclusions:
- Enteral contrast protocols do not appear to decrease the need for surgery or shorten hospitalization for pediatric ASBO.
- Larger randomized trials are recommended to definitively establish the role of radiologic contrast in managing pediatric ASBO.
Objective:
Our objective was to determine the utility of enteral contrast-based protocols in the diagnosis and management of adhesive small bowel obstruction (ASBO) for children.
Background:
Enteral contrast-based protocols for adults with ASBO are associated with a decreased need for surgery and shorter hospitalization. Pediatric-specific data are limited.
Methods:
We conducted a prospective observational study between October 2020 and December 2022 at 9 children's hospitals that are members of the Western Pediatric Surgery Research Consortium. Inclusion criteria were children aged 1 to 20 years diagnosed with ASBO who underwent a trial of nonoperative management at hospital admission. Comparisons were made between those children who received an enteral contrast challenge and those who did not. The primary outcome was the need for surgery.
Results:
We enrolled 136 children (71% male; median age: 12 years); 84 (62%) received an enteral contrast challenge. There was no difference in the rate of operative intervention between the no-contrast (34.6%) and contrast groups (36.9%; P =0.93). Eighty-seven (64%) were successfully managed nonoperatively with no difference in median length of stay ( P =0.10) or rate of unplanned readmission ( P =0.14). Among the 49 children who required an operation, there was no significant difference in the time from admission to surgery or rate of small bowel resection based on prior contrast administration.
Conclusions:
The addition of enteral contrast-based protocols for the management of pediatric ASBO does not decrease the likelihood of surgery or shorten hospitalization. Larger randomized studies may be needed to further define the role of radiologic contrast in the management of ASBO in children.
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