Tailoring the small-bowel follow-through examination postoperatively in gastroschisis patients

Area of Science:

• Pediatric Radiology
• Gastrointestinal Imaging
• Surgical Outcomes

Background:

• Gastroschisis is a congenital abdominal wall defect requiring surgical repair.
• Post-operative management often involves assessing for intestinal obstruction.
• Small-bowel follow-through (SBFT) examinations are used, but current protocols may be inefficient in gastroschisis patients due to dysmotility.

Purpose of the Study:

• To establish an optimized small-bowel follow-through (SBFT) protocol for post-operative gastroschisis patients.
• To improve diagnostic yield and reduce resource utilization in SBFT examinations for this population.

Main Methods:

• Retrospective review of 19 SBFT examinations in 61 gastroschisis patients over 15 years.
• Analysis of examination duration, number of overhead films, and diagnostic accuracy for obstruction.
• Development of a proposed protocol based on observed findings and patient characteristics.

Main Results:

• SBFT examinations were lengthy (average 34 hours) and film-intensive (average 6.7 films).
• Only 1 out of 19 examinations definitively diagnosed intestinal obstruction.
• The majority of examinations were non-diagnostic or showed no obstruction, likely due to gastroschisis-related dysmotility.

Conclusions:

• Current SBFT protocols are often inefficient and yield limited diagnostic information in post-operative gastroschisis patients.
• A revised protocol involving initial fluoroscopic evaluation followed by timed overhead films (30 min, 4h, 12h, then 24h intervals if needed) is recommended.
• The proposed protocol aims to decrease patient radiation, reduce costs, and minimize staff workload.