Management of small bowel obstruction and systematic review of treatment without nasogastric tube decompression

Kyle D Klingbeil, James X Wu, Antonia Osuna-Garcia, Edward H Livingston, Kyle D Klingbeil, James X Wu, Antonia Osuna-Garcia, Edward H Livingston

Abstract

Background: Small bowel obstruction (SBO) is common and its management has evolved in recent years.

Study design: The literature describing adhesive small bowel obstruction (aSBO) treatment was reviewed, and a formal systematic review was performed to identify publications reporting results of aSBO treatment without NGTs.

Results: The annual rate of hospital admission for SBO in the US has increased, with 340,100 admissions in 2019 alone. SBO is usually treated with bowel rest, intravenous hydration and NGT placement. In recent years, water soluble contrast (WSC) has been used as a cathartic to simulate bowel function and may reduce hospital length of stay (HLOS) by 1.95 days (95%CI 0.56-3.3). There were 3 articles of the initial 1650 screened that reported outcomes of SBO treatment without NGTs. These articles included 759 patients, of whom 272 (36%) with aSBO were managed successfully without NGTs. When comparing outcomes to patients who did receive NGT decompression, there were no significant differences in operative rates (28.6% v 16.5%, risk ratio 1.34, 95% CI 1.0, 1.8). Mortality and rates of bowel resection were also not affected by NGT decompression (risk ratio 1.98, 95% CI 0.43, 9.10 and risk ratio 1.56, 95% CI 0.92, 2.65, respectively).

Conclusion: SBO is a common disease process with increasing annual incidence. Use of WSC stimulates the bowel and may reduce HLOS. Modern aSBO treatment protocols should include NGT decompression with consideration of WSC administration. Selection of patients for treatment without NGT decompression requires further investigation.

Keywords: Decompression; Intestinal obstruction; Nasoenteric tube; Nasogastric tube; Small bowel obstruction; Surgical; Water soluble contrast.

Conflict of interest statement

None of the authors have any relevant financial conflict of interest relevant to the submitted publication.

© 2022 The Authors.

Figures

Fig. 1
Fig. 1
Annual incidence of US hospital admissions 1993–2019⁎. ⁎- Data derived from the Heath Care Utilization Project (HCUP). https://hcupnet.ahrq.gov/#setup and https://datatools.ahrq.gov/hcupnet. Temporal trends up to 2014 were based on a hospital admission being associated with a primary diagnostic ICD-9 code of 260.x (intestinal obstruction). After 2016, SBO was identified by the Clinical Classification (CCSR) DIG012-Intestinal Obstruction and Ileus. Data for 2015 were imputed because of missing data attributable to a change in coding systems from ICD-9 to ICD-10 that occurred in that year.

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