Water soluble contrast administration in the management of pediatric adhesive small bowel obstruction: A systematic review and meta-analysis

Objective: Water soluble contrast administration (WSCA) is increasingly being adopted as part of non-operative management (NOM) for adhesive small bowel obstruction (ASBO) in children. We undertook a systematic review and meta-analysis to characterize reported WSCA-based NOM protocols and evaluate their diagnostic and therapeutic efficacy in pediatric ASBO. Methods: A systematic review of four research repositories was conducted in accordance with the PRISMA standards. Two reviewers screened relevant articles for inclusion, with disputes mediated by a third reviewer. Appraisal of risk of bias and certainty of evidence was conducted using the Cochrane ROBINS-I tool and the GRADE approach respectively. Results: Of the 110 unique studies screened, 7 studies reporting 402 cases of pediatric ASBO met criteria. WSCA protocols varied between included studies. Three studies reported test characteristics of WSCA as a means to evaluate risk of progression to surgical intervention, with a pooled sensitivity and specificity of 98.9 % and 83.1 % respectively. Regarding therapeutic benefit, three studies compared progression to surgical intervention between children receiving WSCA-based NOM versus those receiving standard NOM. There was no difference in progression to surgical intervention between the two groups on pooled analysis (pooled OR = 0.66, 95 % CI = 0.11–3.96, I² = 38 %). There were no major WSCA-related complications, including aspiration, anaphylaxis or renal failure, reported in any studies. Conclusion: There is limited evidence to suggest that WSCA-based NOM is associated with reduced progression to surgical intervention. However, given the low risk of complications or adverse events, WSCA may have a role in standardizing care pathways for children with ASBO. Type of Study: Systematic review and meta-analysis. Level of Evidence: Level II evidence (systematic review of non-randomized studies).