Table 1.

Summary of evidence for the use of water-soluble contrast in the management of adhesive small-bowel obstruction

Study	Study design/no. of patients	Supports WSC use	SIGN grade9	Findings
Ceresoli et al.,6 2016	Meta-analysis of 21 studies, 947 diagnostic, some data on therapeutic role	Yes	1+	Provides information on optimal timing of abdominal radiography
Branco et al.,7 2010	Meta-analysis of 14 studies (10 RCT, 4 observational), 508 diagnostic, 765 therapeutic	Yes	1+	Predicted need for surgery, reduced need for surgery, reduced LOS
Abbas et al.,8 2007	Meta-analysis of 10 studies (6 RCT, 4 cohort)	Yes	1+	No reduction in need for surgery, reduced LOS No evidence of therapeutic effect or faster resolution of SBO
Scotté et al.,11 2017	RCT, 242 (121 WSC v. 121 no WSC)	No	1−	No difference in need for surgery or LOS
Farid et al.,12 2010	RCT, 110 (55 WSC v. 55 no WSC)	Yes	1−	Reduced surgery rate (14% v. 35%) and time to resolution
Kumar et al.,13 2009	RCT, 41 (21 WSC v. 20 no WSC)	Yes	1−	Reduced time to resolution (7 h v. 35 h) and LOS No difference in need for surgery
Di Saverio et al.,14 2008	RCT, 76 (38 WSC v. 38 no WSC)	Yes	1−	Reduced surgery rate (19% v. 45%) and LOS
Burge et al.,15 2005	RCT, 35 (18 WSC v. 17 no WSC)	Yes	1−	Reduced LOS
Biondo et al.,16 2003	RCT, 90 (44 WSC v. 46 no WSC)	Yes	1−	Reduced LOS and readmission rate No difference in surgery rate
Choi et al.,17 2002	RCT, 124 initially managed nonoperatively or operatively; those with SBO after 48 h received WSC (19) or operation (16)	Yes	1−	14 who received WSC improved, 5 did not pass so assumed complete obstruction WSC to determine complete v. incomplete obstruction + possible therapeutic effect
Fevang et al.,18 2000	RCT, 98 (48 WSC v. 50 no WSC)	No	1−	Used barium + WSC No effect on surgery rate, LOS, complications, mortality
Feigin et al.,19 1996	RCT, 50 (25 WSC v. 25 no WSC)	No	1−	No effect on surgery rate, LOS, complications, mortality
Miquel et al.,20 2017	Observational, 174 (all WSC)	Yes	2−	WSC showed sensitivity of 75%, specificity of 99%, positive predictive value of 92%, negative predictive value of 98%
Kuehn et al.,21 2017	Observational, 105 (all WSC)	Yes	2−	WSC challenge had specificity of 96%, sensitivity of 100% Accuracy to predict need for exploration was 96%
Zielinski et al.,22 2017	Observational, 316 (173 WSC v. 143 no WSC)	Yes	2+	Reduced surgery rate and LOS
Bueno-Lledo et al.,23 2016	Observational, 235 (all WSC)	Yes	2−	Older age + prior laparotomy for SBO associated with failure of conservative management
Galardi et al.,24 2013	Observational, 103 (72 WSC v. 31 no WSC)	Yes	2+	Shorter time to surgery
Atahan et al.,25 2010	Observational, 37 (all WSC)	Yes	2−	64% improved with WSC; 24% of those who failed still improved nonoperatively
Kapoor et al.,26 2006	Observational, 62 initially managed conservatively; those with SBO after 48 h received WSC (24)	Yes	2−	Resolution within 24 h in 22 patients; remaining 2 patients underwent surgery
Yagci et al.,27 2005	Observational, 317 (199 WSC v. 118 no WSC)	Yes	2+	Reduced surgery rate with WSC (11.6% v. 24.6%)
Aulin et al.,28 2005	Observational, 126 (all WSC); if WSC reached colon within 8 h, trial result was considered negative	Yes	2+	Result was negative in 113 cases (89.7%); in this group, only 2 patients underwent surgery The 13 patients (10.3%) with a positive result underwent surgery Sensitivity, specificity and accuracy of the finding of contrast media reaching the colon as an indicator for conservative treatment were 98%, 100% and 98%, respectively
Choi et al.,29 2005	Observational, 245 (WSC after 48 h); if contrast did not appear in large bowel within subsequent 24 h, patient underwent surgery	Yes	2−	No improvement within 48 h in 44 cases; 2 patients had subsequent surgery because of persistent obstruction, 7 patients underwent complete obstruction surgery Overall operative rate 10%; WSC reduced need for surgery

LOS = length of stay; RCT = randomized controlled trial; SBO = small-bowel obstruction; SIGN = Scottish Intercollegiate Guidelines Network; WSC = water-soluble contrast.