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Session: ePoster: Benign Abdominal 11 (Sat315)

EP104 - Non-Operative Resolution of Small Bowel Obstruction: Characterizing Success of Therapeutic Gastrografin Small Bowel Follow Through

Saturday, May 10, 2025
3:42 PM – 3:47 PM PT
Location: Monitor 1, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Alexandra Jones, MD, MS

    Resident
    University of Louisville
    Louisville, KY, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • AM

    Anne Macleod, MBChB, PhD

    Research Fellow
    Price Institute, University o Louisville
    Louisville, Kentucky, United States

    Disclosure information not submitted.

  • CH

    Cheyenne Hall, MD

    General Surgery Resident
    University of Louisville
    Louisville, Kentucky, United States

    Disclosure information not submitted.

  • JG

    Jeremy Gaskins, N/A

    Associate Professor
    University of Louisville
    Louisville, Kentucky, United States

    Disclosure information not submitted.

  • CR

    Casey R. Rutledge, MD

    Resident Physician
    University of Louisville
    Jeffersonville, Indiana, United States

    Disclosure information not submitted.

  • MP

    Mary Alex Parks, MD

    resident physician
    University of Louisville
    Birmingham, Alabama, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Susan Galandiuk, MD (she/her/hers)

    Division Director
    University of Louisville
    University of Louisville
    Louisville, KY, US

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Alexandra Jones, MD: This individual has no financial relationships with ineligible companies.
Susan Galandiuk, MD: This individual has no relevant relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Gastrografin small bowel follow through (G-SBFT) has long been utilized for diagnosis and treatment of small bowel obstruction (SBO). There is, however, a paucity of data regarding its therapeutic efficacy and which clinical variables predict non-operative SBO resolution following G-SBFT. We sought to determine the therapeutic efficacy of G-SBFT in SBO resolution, the probability of requiring surgery following G-SBFT, the likelihood of being readmitted for SBO following initial resolution and which clinical/radiologic variables predict failure of SBO resolution following G-SBFT.

Methods/Interventions: A single-institution, retrospective review focused upon hospitalized patients undergoing G-SBFT for a clinical diagnosis of SBO between 2018-2023. Patients were identified from two databases: the Hospital Health & Information Management and the Radiology Department database. SBO resolution was defined as return of bowel function (passing flatus/bowel movement) and the ability to tolerate a diet. Demographics and clinical characteristics were expressed as means with standard deviation (SD), and data analyzed using two-sample t-test, Fisher exact test and Mann-Whitney U test. Time from G-SBFT to SBO readmission was evaluated using Kaplan-Meier methods. P-value < 0.05 was considered significant.

Results/Outcomes: 216 inpatients (mean age ± standard deviation, 60.6 ± 16.5yrs) met criteria for diagnostic/therapeutic G-SBFT for SBO. The probability of SBO resolution following G-SBFT was 73% (157/216, 95% confidence interval [CI]: 66-79%). 88% of patients with SBO resolution following G-SBFT did so within 48 hr. Of patients experiencing SBO resolution, 12 re-obstructed during that same admission; 8 then required operation. Overall, 70 patients were operated upon (32%; CI: 26-39%). Forty-seven patients (22%) required readmission a median 80 days later (IQR 24-337 days); of these, 21 (45%) then required an operation. Kaplan-Meier analysis of follow-up data from time of G-SBFT to readmission found the likelihood of not being readmitted at one year to be 79.3% (CI 73.3-85.9%) (Figure 1). Duration of symptoms prior to admission was significantly different between those with resolution of obstruction and those without resolution (p=0.010); 81% of patients with symptom onset within 24 hr of admission experienced SBO resolution compared to only 63% in those with onset >24 hr. None of the other evaluated clinical variables predicted the ability of G-SBFT to lead to SBO resolution, however, passage of contrast to the right colon on G-SBFT was associated with resolution of SBO (p < 0.001) (Table 1).

Conclusion/Discussion: Failure of contrast passage to the right colon and SBO symptom duration prior to admission were associated with non-resolution of SBO following G-SBFT. G-SBFT did lead to SBO resolution in 73% of patients, with 79.3% likelihood of not requiring readmission for SBO at 1 year. In the stable SBO patient, without leukocytosis or clinical peritonitis, G-SBFT is a useful therapeutic tool regardless of underlying pathology.