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Achieving adequate bowel cleansing is of utmost importance for the efficiency of colon capsule endoscopy (CCE). However, information about predictive factors is lacking. The aim of this study was to assess the predictive factors of poor bowel cleansing in the CCE setting.In this observational study, 126 patients who underwent CCE at two tertiary care hospitals were included between June 2017 and January 2020. Participants prepared for bowel cleansing with a 1-day clear liquid diet, a 4-L split-dose polyethylene glycol regimen and boosters with sodium phosphate, sodium amidotrizoate and meglumine amidotrizoate. Domperidone tablets and bisacodyl suppositories were administered when needed. Overall and per-segment bowel cleansing was evaluated using a CCE cleansing score. Simple and multiple logistic regression analysis were carried out to assess poor bowel cleansing and excretion rate predictors.Overall bowel cleansing was optimal in 53 patients (50.5%). Optimal per-segment bowel cleansing was achieved as follows: cecum (86 patients; 74.8%), transverse colon (91 patients; 81.3%), distal colon (81 patients; 75%) and rectum (64 patients; 66.7%). In the univariate analysis, elderly (OR, 1.03; 95% CI (1.01-1.076)) and constipation (OR, 3.82; 95% CI (1.50-9.71)) were associated with poor bowel cleansing. In the logistic regression analysis, constipation (OR, 3.77; 95% CI (1.43-10.0)) was associated with poor bowel cleansing. No variables were significantly associated with the CCE device excretion rate.Our results suggest that constipation is the most powerful predictor of poor bowel cleansing in the CCE setting. Tailored cleansing protocols should be recommended for these patients.

Adhesive small bowel obstructions are a common cause of morbidity in children who underwent prior abdominal surgery. The concept of partial versus complete bowel obstruction is outdated and lacks precision to be clinically useful. Identifying patients with indications for immediate operative intervention is critical and must be recognized to limit morbidity. Clinical protocols and contrast challenge algorithms have attempted to identify patients that will resolve their bowel obstruction nonoperatively; there has been slow uptake in the pediatric patient population versus adults until recently. Incorporating predictive models and standardized contrast challenge protocols will help reduce interpractitioner variability and improve clinical outcomes.

Gastrografin administration (GA) is performed for adhesive small bowel obstruction (ASBO) in cases when decompression therapy using an ileus tube fails to relieve the obstruction. This study evaluated the efficacy of GA and optimized its timing after ileus tube insertion.In this retrospective study, we evaluated data from patients with ASBO admitted between January 2014 and August 2018 and included patients who underwent ileus tube intubation and GA. The patients were classified as those treated with GA within 48 h after admission (early GA [EGA]) and those treated later with GA (delayed GA [DGA]). Propensity score matching was performed to compensate for differences between the groups. Short-term outcomes were compared between the two groups.We included 67 and 80 patients in the EGA and DGA groups, respectively, and 55 pairs with similar background characteristics were matched. The rates of successful conservative management were 87.3% (48/55) in the EGA group, 96.4% (53/55) in the DGA group, and 91.8% (101/110) in the entire sample. The median period of ileus tube insertion in the DGA group was significantly lower than that in the EGA group, whereas other outcomes did not significantly differ between the groups. Aspiration pneumonia occurred in one patient in the EGA group.GA with an ileus tube achieved a high rate of successful conservative management. Follow-up using decompression with an ileus tube for at least 48 h after admission is recommended in patients with ASBO.

With optimized technique, the water-soluble contrast challenge is effective at triaging patients for operative vs non-operative management of suspected small bowel obstruction. Standardized study structure and interpretation guidelines aid in clinical efficacy and ease of use. Many tips and tricks exist regarding technique and interpretation, and their understanding may assist the interpreting radiologist. In the future, a CT-based water-soluble contrast challenge, utilizing oral contrast given as part of the initial CT examination, might allow for a more streamlined algorithm and provide more rapid results.

Introduction The advent of the Gastrograffin® small bowel follow through (G-SBFT) has resulted in a decreased rate of operative intervention of small bowel obstructions (SBO); however, there is no data to suggest when G-SBFT should be performed. Methods We retrospectively reviewed 548 patients, admitted to 1 of 9 hospitals with a diagnosis of SBO. Patients were divided into two categories with regards to timing of G-SBFT: before (early) or after (late) 48 hours from admission. Primary outcomes were length of stay (LOS) and total cost. Secondary outcomes were operative interventions and mortality. Results Of the reviewed patients, 71% had the G-SBFT ordered early. Comparing early versus late, there were no differences in patient characteristics with regards to age, sex, or BMI. There was a significant difference between LOS (4 vs 8 days, P < 0.05) and total cost ($17,056.19 vs $33,292.00, P < 0.05). There was no difference in mortality (1.3% vs 2.6%, P = 0.239) or 30-day readmission rates (15.6% vs 15.9%, P = 0.509). Patients in the early group underwent fewer operations (20.7% vs 31.9%, P = 0.05). Discussion Patients that had a G-SBFT ordered early had a decreased LOS, total cost, and operative intervention. This suggests there is a benefit to ordering G-SBFT earlier in the hospital stay to reduce the overall disease burden, and that it is safe to do so with regards to mortality and readmissions. We therefore recommend ordering a G-SBFT within 48 hours to reduce LOS, cost, and need for an operation

Oral administration of a water-soluble iodine contrast agent (gastrografin) was reported to assist in the appropriate contouring of the small intestine on computed tomography (CT)-based radiotherapy (RT) planning. The efficacy and optimal dose of gastrografin in CT-based image-guided brachytherapy (IGBT) for cervical cancer remain unknown. This study aimed to investigate the efficacy of pretreatment oral administration of gastrografin at a small dose of 50 ml in CT-based IGBT for cervical cancer. A total of 422 sessions in 137 patients who underwent CT-based IGBT with 50 ml of oral gastrografin (concentration, 3% or 4%) were analyzed. Preparation of gastrografin was judged as effective when the small intestine was contrast-enhanced at the area where the small intestine was in contact with the uterus/adnexa. About 287 out of 422 sessions (68%) were judged as effective with gastrografin preparation. The 135 ineffective sessions were considered as follows: (i) the contrast enhancement of the small intestine was not confirmed (n = 36), (ii) the small intestine was not in contact with the uterus/adnexa despite the confirmation of the contrast enhancement of the small intestine (n = 34), and (iii) gastrografin was absent in the small intestine at the area in contact with the uterus/adnexa, even when gastrografin was observed in the small intestine at the area not in contact with the uterus/adnexa (n = 65). In conclusion, pretreatment oral administration of a small dose gastrografin achieved moderate efficacy for accurate contouring of the small intestine close to the uterus/adnexa in CT-based IGBT for cervical cancer.

Gastrografin challenge is increasingly used as a diagnostic tool to predict patients who may benefit from nonoperative management in adhesive small bowel obstruction. This study explores the optimal timing of Gastrografin in the management of adhesive small bowel obstruction by comparing early versus late Gastrografin challenge.A retrospective chart review from January 2016 to January 2018 identified patients with adhesive small bowel obstruction who underwent Gastrografin challenge. A receiver operating characteristic curve, to predict a duration of stay less than 5 days, calculated a 12-hour limit which separated early and late groups. Nonoperative and operative patients were compared separately. Our primary outcome was duration of stay. Secondary outcomes included operative requirement, time to the operating room, complication rate, and 1-year mortality. In a separate analysis, multivariable logistic regression identified independent risk factors for 1-year mortality.One hundred thirty-four patients were identified (58 early, 76 late). In nonoperative patients, the early group had a shorter duration of stay (3.2 days vs 5.4 days), fewer complications, and a lower complication and 1-year mortality rate (P.05). In operative patients, the early group had a shorter preoperative duration of stay (1.8 days vs 3.9 days) (P.05). On multivariable regression, congestive heart failure, any postoperative complication, and operative requirement were the best predictors of 1-year mortality (R2 = 0.321; P.05).Gastrografin administration within 12 hours of adhesive small bowel obstruction diagnosis had favorable outcomes in terms of duration of stay, complications, and mortality in nonoperative patients. Moreover, in operative patients, preoperative duration of stay was shortened. Our findings suggest protocolizing early Gastrografin challenge may be an important principle in adhesive small bowel obstruction management.

We report cause of death after cardiac surgery using isolated cardiopulmonary organ computed tomography angiography (CTA) and a conventional autopsy. A 56-year-old man underwent aortic valve replacement and coronary artery bypass graft surgery under extracorporeal circulation. Massive bleeding occurred suddenly, and the patient died 25 days later. An autopsy revealed fibrinous exudate in the mediastinum and tight attachment of the pericardium to the heart; there were also clots and inflammatory exudate in the chest cavity. Separating the organs in the chest cavity was difficult, especially in the surgical area. We extracted the heart and lungs together and performed cardiovascular CTA and image reconstruction. Results showed spillage of the contrast agent from the anterior wall of the ascending aorta, approximately 4.5 cm from the replaced aortic valve. A histological examination confirmed that the site of contrast agent spillage was the sutured area of the ascending aorta, which was infected, necrotic, and had ruptured. Using the CTA approach for isolated cardiopulmonary organ imaging can accurately display the location of an aortic rupture, which further guides organ inspection and tissue sampling, and avoids irreversible damage to key regions. In conclusion, the approach we describe can provide evidence for determining cause of death.

Background Water-soluble contrast agent (WSCA) administration is commonly used to evaluate adhesive small bowel obstruction (SBO) either via a challenge or follow-through study. This analysis aimed to determine optimal timing to first abdominal radiograph after WSCA administration. Materials and methods A post hoc review of the Eastern Association for the Surgery of Trauma SBO database was used to compare data from two institutions using different methodologies, either the small bowel follow through method or the challenge method, from March 2015-January 2018. The primary outcome was timing of contrast into the colon. Outcomes were also analyzed. A multivariate regression analysis controlled for age, sex, body mass index, previous SBO admissions, and abdominal surgeries. Results A total of 236 patients met inclusion and exclusion criteria (A, 119; B, 117). There were minor demographic differences between cohorts and no significant differences between institutions regarding the confirmed presence of WSCA in the colon, rates of operative intervention, length of operation, hospital length of stay, or 30-d readmission rates.Institution A, where the challenge method was practiced, had 95 (80%) patients with contrast to colon overall; four of 95 (4%) patients had confirmed contrast to colon at or before 7 h, and 89 of 95 (94%) patients had confirmed contrast to colon between 7.1 and 10 h. Institution B, where the small bowel follow through method was practiced, had 94 (80%) patients with contrast to colon overall; 73 of 94 (78%) patients had confirmed contrast to colon at or before 7 h, and 15 of 94 (16%) patients had confirmed contrast to colon between 7.1 and 10 h. Conclusions Either method is effective for evaluation of SBO. Adding a radiograph at 4 h is feasible, could promote earlier disposition, be conducted as part of an emergency department protocol, and possibly allow for the selection of patients who are candidates for outpatient treatment.

Introduction To investigate the impact of two Meglumine-Diatrizoate based bowel preparation regimes for computed tomography colonography (CTC) on the patient experience and image quality. Methods 100 patients consumed Meglumine-Diatrizoate at 24 h and 12 h prior to the CTC examination. 50 patients followed regime 1 (50:50), 50 ml of Meglumine-Diatrizoate at both 24 and 12 h prior to the examination. 50 patients followed regime 2 (75:25), 75 ml of Meglumine-Diatrizoate at 24 h prior to the examination and 25 ml of Meglumine-Diatrizoate at 12 h prior to the examination. All patients completed a questionnaire to indicate the time of onset of adverse effects and when they were most severe. Five advanced practitioners assessed the image quality in a visual grading study. Visual grading characteristic (VGC) analysis was applied with regime 1 as the reference condition and regime 2 and test condition; test alpha was set at 0.05. Results Image quality was assessed with successful bowel cleansing as the scoring criteria for the visual grading study. The bowel cleansing as provided by the two Meglumine-Diatrizoate regimes was revealed not to be statistically different, with the area under the VGC curve and 95% confidence intervals 0.487 (0.287, 0.701), p = 0.887. Patients taking the 75:25 bowel preparation experienced a shorter median time to the onset of adverse effects. Conclusion There was no observed difference in Image quality criteria score for the two Meglumine-Diatrizoate based bowel preparation with more predictable adverse effects of Meglumine-Diatrizoate with the 75:25 preparation. Implications for practice Providing patients with a higher contrast burden 24 h prior to CTC may have a positive impact on the patient experience without compromising image quality.

Objective Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures. Some surgeons still perform routine post-sleeve gastrografin (RSG) study believing that it would detect post-LSG complications, especially leak. In this study, we aimed to evaluate the cost-effectiveness of RSG by considering the cost of the study, length of hospital stay and complications-related costs RSG could prevent. Results A total of 98 eligible patients were included. Of them, 54 patients underwent RSG and 44 did not. Excluding the cost of LSG procedure, the average cost for those who underwent RSG and those who did not in Saudi Riyal (£) was 5193.15 (1054.77) and 4222.27 (857.58), respectively. The average length of stay (ALOS) was practically the same regardless of whether or not the patient underwent RSG. 90.8% (n = 89) of all patients stayed for 3 days. None of the patients developed postoperative bleeding, stenosis or leak. The mean weight, body mass index (BMI) and percentage weight loss (PWL) 6 months postoperatively were found to be 87.71 kg (SD = 17.51), 33.89 kg/m2 (SD = 7.29) and 26.41% (SD = 9.79), respectively. The PWL 6 months postoperatively was 23.99% (SD = 8.47) for females and 30.57 (SD = 10.6) for males (p = 0.01).

ObjectivesPharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3–5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae.MethodsA retrospective case–control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3–5 ml) post-operative gastrografin videofluoroscopy.ResultsIn the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively.ConclusionSmall-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.

Esophageal peroral endoscopic myotomy (POEM) is the treatment of reference of major obstructive esophageal motility disorders but the detection of early complications remains challenging. Our aim was to report the radiological findings on meglumine diatrizoate esophagograms after esophageal POEM and identify variables associated with patient outcomes. The imaging and clinical files of 106 patients who underwent POEM for achalasia or other major obstructive esophageal motility disorders were retrospectively analyzed. Post POEM esophagograms were reviewed for the presence of pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips. Associations between length of hospital stay and radiological findings were searched for using a Cox multivariate analysis. A total of 106 patients (M/F = 56/50; mean age = 50 ± 2 [SD] years) underwent 106 POEM procedures with a meglumine diatrizoate esophagogram on postoperative day 1. Overall median hospital stay was 3 days (range 1–20 days). Pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips were observed in 90/106 (84.9%), 12/106 (11.3%), 4/106 (3.8%), and 0/106 (0%) patients, respectively. At multivariate analysis, pleural effusion (p = 0.005; adjusted hazard ratio [aHR] = 0.35 [95% CI 0.17–0.73]) and extraesophageal contrast leakage (p = 0.039; aHR = 0.27 [95% CI 0.08–0.94]) were associated with a prolonged hospital stay. Pneumoperitoneum was not associated with unfavorable outcome (p = 0.99). Pneumoperitoneum is a common finding after POEM and is not indicative of unfavorable patient outcome. Conversely, post POEM pleural effusion and extraesophageal contrast leakage are associated with a longer hospital stay. • Water-soluble esophagogram is a valid diagnostic modality to diagnose early complications after esophageal endoscopic myotomy for esophageal motility disorders. • At multivariate analysis, pleural effusion and extraesophageal contrast leakage are associated with a prolonged hospital stay after peroral endoscopic myotomy. • Pneumoperitoneum is not associated with unfavorable outcome after peroral endoscopic myotomy.

Background Meconium-related ileus in very low birth weight infants can lead to increased morbidity or mortality and prolonged hospitalization without prompt diagnosis and treatment. This study primarily aimed to identify the incidence of and factors associated with meconium-related ileus and secondarily sought to investigate clinical and growth outcomes after water-soluble contrast media (Gastrografin) enema. Methods We retrospectively reviewed medical records of very low birth weight infants born between February 2009 and March 2019 in the neonatal intensive care unit of a single medical center. Perinatal factors, clinical outcomes, and growth outcomes were compared between the group with meconium-related ileus that received Gastrografin enema and the control group. Results Twenty-four (6.9%) patients were diagnosed with meconium-related ileus among 347 very low birth weight infants. All achieved successful evacuation of meconium with an average of 2.8 (range: 1–8) Gastrografin enema attempts without procedure-related complications. Initiation of Gastrografin enema was performed at mean 7.0 days (range: 2–16) after birth. Incidences of moderate to severe bronchopulmonary dysplasia were higher and the duration of mechanical ventilation and need for oxygen were longer in the meconium-related ileus group (P = 0.039, 0.046, 0.048, respectively). Meconium-related ileus infants took more time to start enteral feeding and the nothing per oral time was longer (P = 0.001 and 0.018, respectively). However, time to achieve full enteral feeding and Z-scores for weight and height at 37 weeks and at 6 months corrected age did not differ between the two groups. Conclusions Gastrografin enema in very low birth weight infants with meconium-related ileus was an effective and safe medical management. Following Gastrografin enema, very low birth weight infants with meconium-related ileus achieved similar subsequent feeding progress and similar growth levels as the control groups without meconium-related ileus.

Background Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen. Methods A post hoc analysis of an Eastern Association for the Surgery of Trauma multi-institutional SBO database was performed including only those receiving GG challenge. Successful nonoperative management (NOM) was defined as passage of flatus or nasogastric tube (NGT) removal. NOM was considered a failure if operative intervention was required. Multiple logistic regression was performed to identify predictors of delayed (>48 h) GG challenge effect and expressed as odds ratios with 95% confidence intervals. Results Of 286 patients receiving GG, 208 patients (73%) were successfully managed nonoperatively. A total of 60 (29%) NOM patients had NGT decompression for >48 h (n = 54) or required >48 h to pass flatus (n = 34), with some requiring both (n = 28). Prior abdominal operations and SBO admission were protective of delayed GG effect (0.411 [0.169-1.00], P Conclusions A significant proportion of patients at 48 h (29%) “failed” the GG challenge as they had yet to pass flatus or still required NGT but were nonetheless successfully managed nonoperatively. Extending the GG challenge beyond 48 h may help avoid unnecessary operations. Level of evidence Level II.

Background/purpose We examined outcomes before and after implementing an enteral water-soluble contrast protocol for management of pediatric adhesive small bowel obstruction (ASBO). Methods Medical records were reviewed retrospectively for all children admitted with ASBO between November 2010 and June 2017. Those admitted between November 2010 and October 2013 received nasogastric decompression with decision for surgery determined by surgeon judgment (preprotocol). Patients admitted after October 2013 (postprotocol) received water-soluble contrast early after admission, were monitored with serial examinations and radiographs, and underwent surgery if contrast was not visualized in the cecum by 24 h. Group outcomes were compared. Results Twenty-six patients experienced 29 admissions preprotocol, and 11 patients experienced 12 admissions postprotocol. Thirteen (45%) patients admitted preprotocol underwent surgery, versus 2 (17%) postprotocol patients (p = 0.04). Contrast study diagnostic sensitivity as a predictor for ASBO resolution was 100%, with 90% specificity. Median overall hospital LOS trended shorter in the postprotocol group, though was not statistically significant (6.2 days (preprotocol) vs 3.6 days (postprotocol) p = 0.12). Pre- vs. postprotocol net operating cost per admission yielded a savings of $8885.42. Conclusions Administration of water-soluble contrast after hospitalization for pediatric ASBO may play a dual diagnostic and therapeutic role in management with decreases in surgical intervention, LOS, and cost. Type of study Retrospective comparative study. Level of evidence Level III.

The use of Gastrografin may have a therapeutic effect on resolving adhesive small bowel obstruction. Adhesive Small Bowel obstruction (ASBO) accounts for the majority of patients with small bowel obstruction. Most patients are managed conservatively; frequent admissions create a considerable burden. We sought to examine the adherence to the Bologna guidelines for the management of ASBO in a high volume tertiary center and whether or not Gastrografin had a therapeutic effect. A comparison was made between an initial retrospective audit looking at ASBO and a prospective re-audit after applying standards derived from the Bologna guidelines. During re-audit it was found that more patients underwent conservative management and fewer patients had surgery as first line management. In the re-audit, those who had to undergo surgery within/after a period of 72h of conservative management were also fewer. Whether they were managed surgically primarily or after a period of conservative management, the average length of stay was also shorter. In comparison to the preliminary audit, there appeared to be no change in the way that medical history and physical examination was documented during the re-audit. However, there was a marked difference in the use of appropriate blood tests and CT scans. Changes were made successfully following the initial audit results and have been implemented, thus closing the audit loop. This study shows that the use of Gastrografin has decreased the need for surgical intervention in a group of patients with small bowel obstruction.

BACKGROUND Small bowel obstruction management has evolved to incorporate the Gastrografin challenge. We expanded its use to the emergency department observation unit, potentially avoiding hospital admission for highly select small bowel obstruction patients. We hypothesized that the emergency department observation unit small bowel obstruction protocol would reduce admissions, costs, and the total time spent in the hospital without compromising outcomes. METHODS We reviewed patients who presented with small bowel obstruction from January 2015 to December 2018. Patients deemed to require urgent surgical intervention were admitted directly and excluded. The emergency department observation unit small bowel obstruction guidelines were introduced in November 2016. Patients were divided into pre and postintervention groups based on this date. The postintervention group was further subclassified to examine the emergency department observation unit patients. Cost analysis for each patient was performed looking at number of charges, direct costs, indirect cost, and total costs during their admission. RESULTS In total, 125 patients were included (mean age 69 ± 14.3 years). The preintervention group (n = 62) and postintervention group (n = 63) had no significant difference in demographics. The postintervention group had a 51% (36.7 hours, P < .001) reduction in median duration of stay and a total cost reduction of 49% (P < .001). The emergency department observation unit subgroup (n = 46) median length of stay was 23.6 hours. The readmission rate was 16% preintervention compared to 8% in the postintervention group (P = .18). CONCLUSION Management of highly selected small bowel obstruction patients with the emergency department observation unit small bowel obstruction protocol was associated with decreased length of stay and total cost, without an increase in complications, surgical intervention, or readmissions.

therapeutic strategy for meconium-related ileus (MRI) in very-low-birth-weight infants (VLBWs) has not been established. This study aims to clarify the optimum therapeutic strategy for MRI in VLBWs.MRI was defined as delayed meconium excretion and microcolon on contrast enema with Gastrografin (diatrizoate acid). Forty-two infants with MRI were treated at our institution between 2009 and 2019, and are reviewed here. They were classified into two groups: in group A (n=21), Gastrografin regurgitated into the dilated intestine during the first or second round of Gastrografin enema (GaE), while in group B (N = 21), Gastrografin did not regurgitate. Laparotomy was indicated if the intestine was perforated, or if abdominal distention was not relieved by two rounds of GaE.in group A, meconium was excreted in all cases within 24 h after GaE, and no cases required laparotomy. In group B, twelve cases (57%) underwent laparotomy (P0.01), six cases in this group (29%), showed free air on X-ray images (P0.01). The median hospital stay in groups A and B were 89.0 and 136.5 days, respectively (P0.05). Overall mortality was 2.4%.early therapeutic diagnosis by GaE followed by early surgery is suggested as the optimum strategy for MRI in VLBWs.

BACKGROUND This retrospective cohort study from a single center aimed to compare patient outcomes following the use of the water-soluble contrast medium Gastrografin in the treatment of adhesive small bowel obstruction (ASBO) in patients with and without a history of chronic radiation enteropathy (CRE). MATERIAL AND METHODS Fifty-nine patients with CRE-induced small bowel obstruction (SBO) and 53 patients with ASBO at Jinling Hospital between April 2014 and February 2018 were enrolled. The patients were given 100 ml Gastrografin through a naso-jejunal tube, and erect abdominal X-rays were taken. Risk factors were found to be correlated with successful non-operative management (SNM) through statistical analyses. RESULTS The success rate of conservative treatment was higher in the Gastrografin group than in the control group (P

Background Postoperative ileus is common and is a major clinical problem. It has been widely studied in patients and in experimental models in laboratory animals. A wide variety of treatments have been tested to prevent or modify the course of this disorder. Purpose This review draws together information on animal studies of ileus with studies on human patients. It summarizes some of the conceptual advances made in understanding the mechanisms that underlie paralytic ileus. The treatments that have been tested in human subjects (both pharmacological and non-pharmacological) and their efficacy are summarized and graded consistent with current clinical guidelines. The review is not intended to provide a comprehensive overview of ileus, but rather a general understanding of the major clinical problems associated with it, how animal models have been useful to elucidate key mechanisms and, finally, some perspectives from both scientists and clinicians as to how we may move forward with this debilitating yet common condition.

Background: This study aimed to investigate the specificity and sensitivity of oral meglumine diatrizoate esophagogram in screening for esophageal fistula during radiotherapy or chemoradiotherapy for esophageal cancer and determine if early detection and intervention could improve the prognosis of esophageal fistulas. Methods: Esophageal cancer patients undergoing radiotherapy or chemoradiotherapy were included. Weekly oral meglumine diatrizoate esophagograms were performed to screen for esophageal fistulas during radiotherapy. When an esophageal fistula was detected, fibroesophagoscopy and computed tomography (CT) were used for confirmation; once confirmed, radiotherapy was discontinued, and the patient received intervention. The esophagogram results were reviewed weekly to assess the recovery of the esophageal fistula. If the fistula was healed, the patient resumed and completed radiotherapy. Results: A total of 206 patients with cancer of the esophagus undergoing chemotherapy/radiotherapy were included. During radiotherapy, 10 cases of esophageal fistula were detected or suspected based on the oral meglumine diatrizoate esophagography findings, and eight of those cases were confirmed by CT and esophagoscopy. All patients with esophageal fistula received intervention; among them, 62.5% (5/8) recovered after 1 to 2 weeks of treatment and continued radiotherapy to completion. The sensitivity and specificity of oral meglumine diatrizoate esophagography in screening for esophageal fistulas during radiotherapy or chemoradiotherapy were 100 and 98.9%, respectively. The median survival period of patients with esophageal fistulas was 6.4 months. Conclusion: Oral meglumine diatrizoate esophagography has high sensitivity and specificity in screening for esophageal fistulas during radiotherapy or chemoradiotherapy with minimal side effects. Early diagnosis and timely intervention can significantly improve the prognosis and prolong the survival period of patients. Trial Registration: Chictr.org.cn, Identifier: ChiCTR-DDD-17012617. Registered on September 7, 2017. The first participant was enrolled on September 25, 2017. http://www.chictr.org.cn/showproj.aspx?proj=21526.

Three-dimensional image-guided brachytherapy (3D-IGBT) using computed tomography (CT) is an essential component of definitive radiation therapy for uterine cervical cancer (UCC). Treatment planning for CT-based 3D-IGBT requires delineating the high-risk clinical target volume (CTVHR) and the organs at risk (OARs), which is difficult when the small intestine is adjacent to those delineation targets. Uncertainty in target delineation threatens the validity of 3D-IGBT treatment plans. To address this issue, we introduce the use of diatrizoate meglumine and diatrizoate sodium (gastrografin), an orally administrable iodine-based radiopaque contrast agent. We present two cases of UCC treated with CT-based 3D-IGBT and describe how intraluminal enhancement of the small intestine by oral gastrografin pretreatment facilitated discrimination between the small intestine and the adjacent CTVHR (case no.1) or the rectosigmoid colon (case no. 2). Oral gastrografin pretreatment is a simple and cost-effective method that allows distinguishing the small intestine from the adjacent delineation target (i.e., CTVHR and the OARs) in CT-based 3D-IGBT for UCC.

Gastrointestinal decompression is generally applied to a non-strangulated acute small bowel obstruction (NSASBO). Although long tube (LT) placement and administration of Gastrografin through a nasogastric tube (NGT-G) have shown advantages over NGT alone in previous studies, no studies appear to have compared LT and NGT-G. In this multicenter, randomized controlled trial, patients with NSASBO were randomly assigned to receive LT or NGT-G between July 2016 and November 2018 at 11 Japanese institutions. The primary endpoint was non-inferiority of NGT-G compared to LT for non-surgery rate, and the lower limit of the 95% confidence interval for the non-surgery rate (−15%) was set as the lower margin for inferiority of NGT-G compared to LT. In total, 223 patients (LT group, n = 111; NGT-G group, n = 112) were analyzed in the present trial. The non-surgery rate was 87.4% in the LT group and 91.1% in the NGT-G group, with a 3.7% difference between NGT-G and LT (95.3%CI − 5.55 to 12.91; non-inferiority P = 0.00002923). On the other hand, the non-surgery rate with pure NGT-G alone (76.8%) that represents non-cross-over NGT-G without subsequent LT was significantly lower than that with LT (P = 0.039). Median procedure time was significantly shorter with NGT-G (1 min) than with LT (25 min; P

Background Contrast induced diabetic nephropathy (CIN) is an important cause of hospital-acquired acute renal failure. Our aim was to observe the effect of protein kinase C β2 (PKCβ2) knockdown on human proximal tubular epithelial cells (HK-2 cells) against meglumine diatrizoate and advanced glycation end products (AGEs)-induced apoptosis and autophagy. Methods Cell viability was detected using cell counting kit-8 (CCK-8) assay in HK-2 cells after disposal with meglumine diatrizoate and AGEs with or without PKCβ2 siRNA/inhibitor LY333531. Flow cytometry and western blot were used to test cell apoptosis and the related protein levels in meglumine diatrizoate and AGEs co-treated HK-2 cells with or without PKCβ2 siRNA/inhibitor LY333531. Autophagy related proteins were detected using western blot. Immunofluorescence staining was used to examine the autophagy-specific protein light chain 3 (LC3), and autophagosome and autolysosome formation was observed under a transmission electron microscopy. Results CCK-8 assay results showed that meglumine diatrizoate inhibited AGEs-induced HK-2 cell viability. Furthermore, meglumine diatrizoate promoted cell apoptosis and the expression level of caspase3 in AGEs-induced HK-2. Western blot results showed that meglumine diatrizoate elevated the expression levels of PKCβ2 and p-PKCβ2 in AGEs-induced HK-2 cells, and up-regulated the expression level of Beclin-1 and the ratio of LC3 II/LC3 I, and down-regulated the expression level of p62 in AGEs-induced HK-2 cells. We found that PKCβ2 knockdown alleviated meglumine diatrizoate and AGEs-induced HK-2 cell apoptosis and autophagy. Intriguingly, PKCβ2 inhibitor LY333531 reversed 3-methyladenine (3-MA)-induced autophagy inhibition in meglumine diatrizoate and AGEs-induced HK-2 cells. Conclusions Our findings reveal that inhibiting PKCβ2 protects HK-2 cells against meglumine diatrizoate and AGEs-induced apoptosis and autophagy, which provide a novel therapeutic insight for CIN in diabetic patients.

To assess the frequency and indications for use of oral water-soluble contrast challenge as a diagnostic test for small bowel obstruction in four regions of the USA. We distributed a 9-question web-based survey to the abdominal section heads of academic radiology departments throughout the USA (N = 97). The questions pertained to use of water-soluble contrast for management of small bowel obstruction. Descriptive statistics and Fisher’s exact tests were used for data analysis. The overall response rate was 46%. Eighty percent of the responding hospitals had more than 500 beds in operation. Water-soluble contrast challenge was considered standard of care for management of non-operative small bowel obstruction in 60% of the responding radiology departments. The majority of the responding departments (41%) performed 2–8 contrast challenge studies per month on average. The most frequent indication for the study was distinguishing partial vs complete bowel obstruction. Eighty percent of the responding radiologists believed that the contrast challenge is useful for management of small bowel obstruction. Overall, there was no statistically significant difference in frequency and indication for use of water-soluble contrast challenge based on geographic location. The water-soluble contrast challenge was considered standard of care for non-operative management of small bowel obstruction in majority of the academic radiology departments represented in this survey. Surgeons were referring clinicians in every case. The most common clinical indication for the study was distinguishing partial versus complete small bowel obstruction.