THE ROLE OF THE EARLY GASTROGRAFIN TEST IN A DECISION-MAKING ALGORITHM FOR THE MANAGEMENT OF PATIENTS WITH ADHESIVE SMALL BOWEL OBSTRUCTION (ASBO)

Introduction: The Gastrografin Test (GT) is a very useful tool for the management of ASBO without signs of peritonitis which facilitates the recognition of patients who will benefit from a surgical operation 1,2. The aim of this study is to analyze the results of GT protocol use and to identify failure predictive factors. Material and methods: During 2015-2016, 90 patients with overall 92 ASBO episodes were managed in our Unit using a decision-making algorithm. In 80 cases (87%), a conservative treatment with GT was adopted. We prospectively analyze patients’demographic data and diagnostic CT work-up (wall thickening [ 5 mm, mean small bowel maximum caliber, fluid collection and parietal pneumatosis). Results: 31 ASBO episodes (39%) were successfully managed with a conservative treatment with Gastrographin (group 1, G1). The remaining 49 episodes (61%) required a surgical exploration (group 2, G2). The incidence of intestinal wall thickening [ 5 mm was significantly higher in G1 (49% vs 19,4%, p = 0,015). The same was identified for the mean small bowel maximum caliber (4,35 cm vs 3,7 cm, p = 0,002). The latter parameter (p = 0,011; OR 2,6; IC 95%) and the wall thickening (p = 0,026; OR: 3,88; IC 95%) can be considered as predictive factors of GT failure Conclusion: GT is a safe and effective tool in the management of ASBO not requiring emergency surgery. It may be helpful in establishing whether or not to perform surgery. The mean small bowel maximum caliber and the intestinal wall thickening can be considered as predictive factors for GT failure. References: 1. Di Saverio S et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2013; 8 (1): 42-51. 2. Azagury D et al. Small bowel obstruction: a practical step-by-step evidence-based approach to evaluation, decision making and management J Trauma Acute Care Surg 2015; 79 (4): 661-668. Disclosure: No significant relationships.