Bottom line: Water-soluble contrast followed by an abdominal x-ray after at least 4 hours can predict the likelihood of resolution of a small bowel obstruction. There is no evidence that Gastrografin reduces the need for surgery in patients with an adhesive small bowel obstruction, but there is evidence that Gastrografin reduces the length of hospital stay in patients with adhesive small bowel obstruction that do not need surgery.
Summary: Abbas S, Bissett IP, Parry BR. Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004651. DOI: 10.1002/14651858.CD004651.pub3.
Systematic review of 6 prospective studies to evaluate use of oral water soluble contrast for diagnosis and 6 randomized trials to evaluate therapeutic role (only 1 of the randomized trials adequately described blinding and allocation concealment.) RESULTS: The appearance of water-soluble contrast in cecum on abdominal x-ray within 24 hours predicts resolution of adhesive bowel obstruction with pooled 97% sensitivity and 96% specificity. A meta-analysis of 6 randomized trials of Gastrografin did not find reduced need for surgery but meta-analysis of 4 trials of Gastrografin found reduced length of stay compared with placebo (p < 0.001)