Therapeutic use of Gastrografin in the management of adhesional and non-adhesional bowel obstruction

Introduction The standardisation of Gastrografin (GG) use in small bowel obstruction (SBO) remains a challenge in emergency surgery. Methods A retrospective audit was performed to assess clinical practice using the Bologna guidelines, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report ‘Delay in Transit’ and the National Audit of Small Bowel Obstruction (NASBO) report as a standard. Patient outcomes were reported. Data were collected for admissions between January 2022 and December 2022. Patients diagnosed with SBO who received GG as part of their treatment were included. Patients with large bowel obstruction, those who did not receive GG or who received GG for non-surgical pathologies or diagnostic purposes were excluded. Results Some 111 patients with 113 episodes of SBO (65 females, 48 males) with mean age of 70 years were eligible. There were 92 episodes (81%) of adhesive SBO (group 1) and 21 (19%) of non-adhesive SBO (group 2). In group 1, obstruction resolved within 72h of GG challenge in 62 cases (67%) and 30 cases failed GG challenge (33%). Eventually, 25 (27%) patients were operated on. The compliance rate with Bologna guidelines was 87%. In group 2, 14 cases (67%) had success with GG, 3 (14%) required surgery and in 4 cases (19%) obstruction resolved after 72h without surgery. Overall mortality rate was 4% (n = 5). Conclusions This study provides an overview of the role of GG in the management of all-cause SBO. GG was used in a limited number of non-adhesive SBO cases showing a potential therapeutic role. Larger studies are required to estimate patient outcomes and to define evidence-based indications in non-adhesive bowel obstruction.