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 grade (9)	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.