Clinical and Financial Impact of an Evidenced-Based Adhesive Small Bowel Obstruction Management Protocol
Status: | Withdrawn |
---|---|
Conditions: | Gastrointestinal |
Therapuetic Areas: | Gastroenterology |
Healthy: | No |
Age Range: | 18 - Any |
Updated: | 12/6/2018 |
Start Date: | September 1, 2015 |
End Date: | September 13, 2017 |
This research study is for patients with adhesive small bowel obstruction (ASBO). ASBO is a
condition in which the small intestine gets blocked due to scars called adhesions. To see the
blockage, a contrast agent is given and an x-ray is taken of the belly (abdomen). MD
Gastroview and omnipaque are two contrast agents that may be given as part of your normal
care for ASBO. This study hopes to see if one is better than the other.
condition in which the small intestine gets blocked due to scars called adhesions. To see the
blockage, a contrast agent is given and an x-ray is taken of the belly (abdomen). MD
Gastroview and omnipaque are two contrast agents that may be given as part of your normal
care for ASBO. This study hopes to see if one is better than the other.
Small bowel obstruction is a common general surgical diagnosis providing a significant
proportion (16%) of the emergency general surgery admissions. Unfortunately, there is a
paucity of clear, well defined management protocols for this very common problem which
results in a wide array of management techniques used by the general surgeon. It has already
been shown that CT scan with IV contrast is the most accurate method of identifying
strangulated bowel, a diagnosis that requires urgent surgical intervention(4). There is no
variability in this aspect of the treatment arm for ASBO, rather the variability is found in
the medical management of ASBO. Nasogastric tube (NGT) decompression is a universal component
of non-operative management but the duration of NGT therapy and the definition of failed
medical management requiring surgery lack a clear consensus. It is this aspect of the
management of ASBO that I am hoping to better define. Water soluble contrast (MD-Gastroview)
has been shown to be both diagnostic and therapeutic in the management of ASBO decreasing
length of stay in this patient population. Not only does it expedite the resolution of ASBO,
but is also yields objective evidence whether or not ASBO will resolve with medical
management alone, therefore decreasing delay in the inevitable surgical intervention.
The hypothesis of this study is that the implementation of an evidence based adhesive small
bowel obstruction protocol can reduce length of stay and reduce the financial burden on the
health care system regarding this common general surgical problem. A second hypothesis is
that MD-Gastroview and omnipaque will have similar properties regarding their diagnostic and
therapeutic impact on ASBO.
proportion (16%) of the emergency general surgery admissions. Unfortunately, there is a
paucity of clear, well defined management protocols for this very common problem which
results in a wide array of management techniques used by the general surgeon. It has already
been shown that CT scan with IV contrast is the most accurate method of identifying
strangulated bowel, a diagnosis that requires urgent surgical intervention(4). There is no
variability in this aspect of the treatment arm for ASBO, rather the variability is found in
the medical management of ASBO. Nasogastric tube (NGT) decompression is a universal component
of non-operative management but the duration of NGT therapy and the definition of failed
medical management requiring surgery lack a clear consensus. It is this aspect of the
management of ASBO that I am hoping to better define. Water soluble contrast (MD-Gastroview)
has been shown to be both diagnostic and therapeutic in the management of ASBO decreasing
length of stay in this patient population. Not only does it expedite the resolution of ASBO,
but is also yields objective evidence whether or not ASBO will resolve with medical
management alone, therefore decreasing delay in the inevitable surgical intervention.
The hypothesis of this study is that the implementation of an evidence based adhesive small
bowel obstruction protocol can reduce length of stay and reduce the financial burden on the
health care system regarding this common general surgical problem. A second hypothesis is
that MD-Gastroview and omnipaque will have similar properties regarding their diagnostic and
therapeutic impact on ASBO.
Inclusion Criteria:
- Principle diagnosis of adhesive small bowel obstruction
Exclusion Criteria:
- Evidence of strangulation on initial CT scan leading to emergent operation
- Any known allergy to either contrast agent
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