Sending dye through the small intestine to look for blockages has been sparing a significant proportion of patients from needing to undergo surgery, a new study shows.
The dye, Gastrografin from Bracco Diagnostics Inc., is administered to symptomatic patients before an X-ray or CT scan so that surgeons can see the location and severity of any so-called adhesive small bowel obstructions.
Researchers reviewed nationwide data on more than 20,000 patients with suspected small bowel obstruction managed in two periods - 2012 to 2016, before Gastrografin was widely used for this purpose, and 2019 to 2023, when using Gastrografin to visualize intestinal blockages was a standard of care.
They found nearly a 45% decrease in surgeries for small bowel obstruction in the Gastrografin era, from 13,257 to 7,333.
Small bowel obstruction accounts for 15% of hospital admissions in the U.S., with about 20% of cases needing surgery to reconstruct the intestine, the researchers said. The resulting healthcare costs total over $3 billion each year.
Despite better small bowel obstruction outcomes overall, post-surgery mortality increased from 4.4% to 5.9% after use of the dye became standard, and reoperations within 30 days rose from 4.7% to 6.2% - likely because surgeries were probably more complex in the later era, the researchers said.
Gastrografin testing had weeded out patients with relatively mild obstructions who ultimately didn't need surgery, they added.
"Previously, patients who had a relatively mild adhesive small bowel obstruction would have been operated on, as we didn't have an alternative option," study leader Dr. Robert McLoughlin from the University of Connecticut School of Medicine in Farmington said in an email.
"This meant that in the post-Gastrografin era, the surgeries were more complex and challenging, hence the increased morbidity and mortality."
Still, because surgeons have gotten better at managing patients after surgery for small bowel obstructions, patients in the Gastrografin group averaged 6 days in the hospital, versus about 10 days for patients treated before the Gastrografin era, the researchers reported in the Journal of Surgical Research.
The current study was not designed to prove that any of the outcomes were the result of Gastrografin use, the article pointed out.
McLoughlin recalled that during a discussion with a younger colleague about managing small bowel obstructions, he mentioned that when he was in training, surgeons operated "on a lot more" of these patients. The colleague, Dr. Yuen-Joyce Liu, then suggested the current study, McLoughlin said.
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