Milne Tony G E, Vather Ryash, O'Grady Gregory, Miquel Jordi, Biondo Sebastiano, Bissett Ian
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Colorectal Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand.
ANZ J Surg. 2018 Mar 6. doi: 10.1111/ans.14443.
Gastrografin has been suggested as a rescue therapy for prolonged post-operative ileus (PPOI) but trial data has been inconclusive. This study aimed to determine the benefit of gastrografin use in patients with PPOI by pooling the results of two recent randomized controlled trials assessing the efficacy of gastrografin compared to placebo given at time of PPOI diagnosis.
Anonymized, individual patient data from patients undergoing elective bowel resection for any indication were included, stoma closure was excluded. The primary outcome was duration of PPOI. Secondary outcomes were time to tolerate oral diet, passage of flatus/stool, requirement and duration of nasogastric tube, length of post-operative stay and rate of post-operative complications.
Individual patient data were pooled for analysis (53 gastrografin, 55 placebo). Gastrografin trended towards a reduction in PPOI duration compared to placebo, respectively, median 96 h (interquartile range, IQR, 78 h) versus median 120 h (IQR, 84 h), however, this result was non-significant (P = 0.11). In addition, no significant difference was detected between the two groups for time to passage of flatus/stool (P = 0.36) and overall length of stay (P = 0.35). Gastrografin conferred a significantly faster time to tolerate an oral diet compared to placebo (median 84 h versus median 107 h, P = 0.04). There was no difference in post-operative complications between the two interventions (P > 0.05).
Gastrografin did not significantly reduce PPOI duration or length of stay after abdominal surgery, but did reduce time to tolerate a solid diet. Further studies are required to clarify the role of gastrografin in PPOI.
泛影葡胺已被提议作为术后肠梗阻延长（PPOI）的一种挽救疗法，但试验数据尚无定论。本研究旨在通过汇总两项近期随机对照试验的结果来确定使用泛影葡胺对PPOI患者的益处，这两项试验评估了在PPOI诊断时给予泛影葡胺与安慰剂相比的疗效。
纳入因任何适应证接受择期肠切除患者的匿名个体患者数据，排除造口关闭患者。主要结局是PPOI的持续时间。次要结局包括耐受口服饮食的时间、排气/排便时间、鼻胃管的需求及持续时间、术后住院时间和术后并发症发生率。
对个体患者数据进行汇总分析（53例使用泛影葡胺，55例使用安慰剂）。与安慰剂相比，泛影葡胺有使PPOI持续时间缩短的趋势，分别为中位96小时（四分位间距，IQR，78小时）和中位120小时（IQR，84小时），然而，该结果无统计学意义（P = 0.11）。此外，两组在排气/排便时间（P = 0.36）和总住院时间（P = 0.35）方面未检测到显著差异。与安慰剂相比，泛影葡胺使患者耐受口服饮食的时间显著加快（中位84小时对中位107小时，P = 0.04）。两种干预措施的术后并发症无差异（P>0.05）。
泛影葡胺并未显著缩短腹部手术后PPOI的持续时间或住院时间，但确实缩短了耐受固体饮食的时间。需要进一步研究以阐明泛影葡胺在PPOI中的作用。
