Prognostic factors to identify resolution of small bowel obstruction without need for operative management : systematic review
© 2023. The Author(s)..
OBJECTIVES: To identify imaging, clinical, and laboratory variables potentially prognostic for surgical management of small bowel obstruction.
METHODS: Two researchers systematically reviewed indexed literature 2001-2021 inclusive for imaging, clinical, and laboratory variables potentially predictive of surgical management of small bowl obstruction and/or ischaemia at surgery, where performed. Risk of bias was assessed. Contingency tables for variables reported in at least 5 studies were extracted and meta-analysed to identify strong evidence of association with clinical outcomes, across studies.
RESULTS: Thirty-one studies were ultimately included, reporting 4638 patients (44 to 313 per study). 11 (35%) studies raised no risk of bias concerns. CT was the modality reported most (29 studies, 94%). Meta-analysis of 21 predictors identified 5 strongly associated with surgical intervention, 3 derived from CT (peritoneal free fluid, odds ratio [OR] 3.24, 95%CI 2.45 to 4.29; high grade obstruction, OR 3.58, 95%CI 2.46 to 5.20; mesenteric inflammation, OR 2.61, 95%CI 1.94 to 3.50; abdominal distension, OR 2.43, 95%CI 1.34 to 4.42; peritonism, OR 3.97, 95%CI 2.67 to 5.90) and one with conservative management (previous abdominopelvic surgery, OR 0.58, 95%CI 0.40 to 0.85). Meta-analysis of 10 predictors identified 3 strongly associated with ischaemia at surgery, 2 derived from CT (peritoneal free fluid, OR 3.49, 95%CI 2.28 to 5.35; bowel thickening, OR 3.26 95%CI 1.91 to 5.55; white cell count, OR 4.76, 95%CI 2.71 to 8.36).
CONCLUSIONS: Systematic review of patients with small bowel obstruction identified four imaging, three clinical, and one laboratory predictors associated strongly with surgical intervention and/or ischaemia at surgery.
CLINICAL RELEVANCE STATEMENT: Via systematic review and meta-analysis, we identified imaging, clinical, and laboratory predictors strongly associated with surgical management of small bowel obstruction and/or ischaemia. Multivariable model development to guide management should incorporate these since they display strong evidence of potential utility.
KEY POINTS: • While multivariable models incorporating clinical, laboratory, and imaging factors could predict surgical management of small bowel obstruction, none are used widely. • Via systematic review and meta-analysis we identified imaging, clinical, and laboratory variables strongly associated with surgical management and/or ischaemia at surgery. • Development of multivariable models to guide management should incorporate these predictors, notably CT scanning, since they display strong evidence of potential utility.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
European radiology - (2023) vom: 08. Nov. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Eze, Vivienne N [VerfasserIn] |
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| Links: |
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| Themen: |
CT |
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| Anmerkungen: |
Date Revised 08.11.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1007/s00330-023-10421-9 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM36430135X |
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| 100 | 1 | |a Eze, Vivienne N |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prognostic factors to identify resolution of small bowel obstruction without need for operative management |b systematic review |
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| 500 | |a Date Revised 08.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a OBJECTIVES: To identify imaging, clinical, and laboratory variables potentially prognostic for surgical management of small bowel obstruction | ||
| 520 | |a METHODS: Two researchers systematically reviewed indexed literature 2001-2021 inclusive for imaging, clinical, and laboratory variables potentially predictive of surgical management of small bowl obstruction and/or ischaemia at surgery, where performed. Risk of bias was assessed. Contingency tables for variables reported in at least 5 studies were extracted and meta-analysed to identify strong evidence of association with clinical outcomes, across studies | ||
| 520 | |a RESULTS: Thirty-one studies were ultimately included, reporting 4638 patients (44 to 313 per study). 11 (35%) studies raised no risk of bias concerns. CT was the modality reported most (29 studies, 94%). Meta-analysis of 21 predictors identified 5 strongly associated with surgical intervention, 3 derived from CT (peritoneal free fluid, odds ratio [OR] 3.24, 95%CI 2.45 to 4.29; high grade obstruction, OR 3.58, 95%CI 2.46 to 5.20; mesenteric inflammation, OR 2.61, 95%CI 1.94 to 3.50; abdominal distension, OR 2.43, 95%CI 1.34 to 4.42; peritonism, OR 3.97, 95%CI 2.67 to 5.90) and one with conservative management (previous abdominopelvic surgery, OR 0.58, 95%CI 0.40 to 0.85). Meta-analysis of 10 predictors identified 3 strongly associated with ischaemia at surgery, 2 derived from CT (peritoneal free fluid, OR 3.49, 95%CI 2.28 to 5.35; bowel thickening, OR 3.26 95%CI 1.91 to 5.55; white cell count, OR 4.76, 95%CI 2.71 to 8.36) | ||
| 520 | |a CONCLUSIONS: Systematic review of patients with small bowel obstruction identified four imaging, three clinical, and one laboratory predictors associated strongly with surgical intervention and/or ischaemia at surgery | ||
| 520 | |a CLINICAL RELEVANCE STATEMENT: Via systematic review and meta-analysis, we identified imaging, clinical, and laboratory predictors strongly associated with surgical management of small bowel obstruction and/or ischaemia. Multivariable model development to guide management should incorporate these since they display strong evidence of potential utility | ||
| 520 | |a KEY POINTS: • While multivariable models incorporating clinical, laboratory, and imaging factors could predict surgical management of small bowel obstruction, none are used widely. • Via systematic review and meta-analysis we identified imaging, clinical, and laboratory variables strongly associated with surgical management and/or ischaemia at surgery. • Development of multivariable models to guide management should incorporate these predictors, notably CT scanning, since they display strong evidence of potential utility | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a CT | |
| 650 | 4 | |a Intestinal ischaemia | |
| 650 | 4 | |a Intestinal obstruction | |
| 650 | 4 | |a Meta-analysis | |
| 650 | 4 | |a Systematic review | |
| 700 | 1 | |a Parry, Tom |e verfasserin |4 aut | |
| 700 | 1 | |a Boone, Darren |e verfasserin |4 aut | |
| 700 | 1 | |a Mallett, Sue |e verfasserin |4 aut | |
| 700 | 1 | |a Halligan, Steve |e verfasserin |4 aut | |
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