The Effect of Hyperosmolar Water-Soluble Contrast for the Management of Adhesive Small-Bowel Obstruction: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
INTRODUCTION: Guidelines recommend using water-soluble contrast (WSC) to treat adhesive small-bowel obstruction (aSBO). Its effectiveness is uncertain. METHODS: A systematic review and meta-analysis was performed (January 1, 1990 to November 1, 2021). Study quality was assessed by the Cochrane risk-of-bias and the Newcastle-Ottawa tools. Enhanced versions of Consolidated Standards of Reporting Trials and Strengthening the Reporting of Observational Studies in Epidemiology checklists were also included. Randomized controlled trials (RCTs) and observational studies were analyzed separately. The therapeutic effect of WSC was assessed by operative rate and hospital length of stay (HLOS) in nonsurgical patients. Rate of bowel resection, complication, mortality, time-to-operation, and quality-of-life assessments were also analyzed. RESULTS: We identified 11 eligible RCTs that included 817 patients and 9 observational studies of 3,944 patients. HLOS in nonsurgical patients decreased by 1.95 days (95% CI 0.56 to 3.3) in the RCTs and could not be assessed in the observational studies. The RCTs showed no effect of WSC on operative rate, but there were fewer operations in the WSC group (11%) compared with controls (16%) within the observational studies (risk ratio 0.56, 95% CI 0.39 to 0.82). There was no effect of WSC on rate of bowel resection, complication, or mortality. Additional outcomes could not be assessed given insufficient reporting. There was substantial heterogeneity among the studies, in part, due to a lack of standardized WSC protocols (Fig. 1).CONCLUSION: Operative rate and HLOS in nonsurgical patients may be reduced by the administration of WSC in aSBO. The current literature is heterogeneous with considerable design limitations. High-quality RCTs are needed using standardized protocols to determine the true benefits of WSC for the management of aSBO.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.035 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.033 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".