[Comparison of therapeutic efficacy of treatment with hyperbaric oxygen versus a long intestinal tube for adhesive small bowel obstruction and paralytic ileus].

PURPOSE: Gastrointestinal cancer surgery is often complicated by adhesive small bowel obstruction (ASBO) and paralytic ileus (PI), managed with a long intestinal tube (LIT), surgery, or hyperbaric oxygen therapy (HBOT). LIT insertion is challenging for both patients and medical staff, whereas HBOT requires only bed rest. However, HBOT has not been reported in clinical practice. Therefore, this study aimed to investigate its use for postoperative ASBO in patients with gastrointestinal cancer.

METHODS

This single-center, retrospective study included gastrointestinal cancer patients with postoperative ASBO between January 2012 and March 2023. A total of 126 patients (mean age 77.3 years) diagnosed with ASBO or PI at our hospital were assigned to either HBOT (96 patients) or LIT (30 patients). The primary outcome was the fasting period. Responders were defined as cases that resolved with a single treatment.

RESULTS

The fasting periods did not differ significantly between the HBOT group (median [IQR], 5 [4-7] days) and the LIT group (5 [4-7.8] days;p=0.574). Among responders, the fasting period was also not significantly longer in the HBOT group (5 [3-7] days) than in the LIT group 5 [4-7.3] days;p=0.181). HBOT non-responders were significantly more emetic (94% vs 63%, p=0.018) and older (mean 82.0 vs 75.1 years;p=0.023) than HBOT responders.

CONCLUSION

HBOT appears no less effective than LIT for patients with ASBO or PI and offers greater comfort. It may be preferable for patients with mild vomiting, improvement after nasogastric tube placement, age <77 years, lower CRP, moderate intestinal dilatation, and within 24 hours of onset.