Water-soluble contrast agent use in adhesional small bowel obstruction: a survey of surgical practices and clinical trial considerations.

BACKGROUND

The role of water-soluble contrast agent (WSCA) as a therapeutic tool in the nonoperative management of adhesional small bowel obstruction (ASBO) remains indeterminate. This survey aimed to understand current surgical practices in WSCA use in the conservative approach to ASBO, and to evaluate key design and feasibility factors to inform a future controlled trial of WSCA in ASBO.

METHODS

This study is reported in line with CROSS guidance. The survey consisted of 16 questions organised into three sections: respondent characteristics, current decision-making and WSCA use, and opinions on future trial. Pilot testing was conducted before online distribution to surgeons in the UK delivering Emergency General Surgery. Descriptive analysis was performed.

RESULTS

Of 73 total respondents, 52 (71.2%) were consultants. When treating ASBO conservatively, 80.8% (59/73) reported using WSCA in more than half of cases, but there was wide variation in timings, use and repeat challenges. Between 71.2% and 89.0% of respondents affirmed their willingness to adhere to specific trial protocols. Regarding feasibility, 76.7% (56/73) of respondents agreed or strongly agreed that they would be willing to recruit to a trial and 75.3% (55/73) agreed or strongly agreed that their unit would be able to deliver a trial.

CONCLUSIONS

The survey revealed widespread acceptance of WSCA as a therapeutic tool in ASBO among emergency general surgeons. Although practices around its administration varied, there was a clear readiness to adopt standardised protocols. The majority of respondents expressed support for a controlled trial comparing WSCA against a placebo.