Gu Lili, Ding Chao, Tian Hongliang, Yang Bo, Zhang Xuelei, Hua Yue, Gong Jianfeng, Li Ning
Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
ANZ J Surg. 2019 Mar;89(3):239-243. doi: 10.1111/ans.14863. Epub 2018 Oct 8.
BACKGROUND/AIM: Faecal impaction (FI) is a common cause of lower gastrointestinal tract obstruction. Gastrografin is a water-soluble radiologic contrast agent that may be orally or rectally administered, with proved therapeutic benefits in adhesive small bowel obstruction. Enemas have long been advocated as the best treatment for FI. The purpose of this study was to demonstrate that enteral administration of gastrografin might be more effective than enema in FI treatment inducing intestinal obstruction.
A double-blinded, controlled and randomized trial was conducted. Participants received 100 mL of gastrografin (gastrografin group) through nasointestinal tube or enemas (enema group) once daily for six consecutive days. Successful faecal disimpaction, FI time to resolution, Bristol Stool Scale, constipation severity, symptom assessment and adverse events were evaluated.
A total of 124 patients were eligible, but only 83 were enrolled to this trial (mean age: 44 ± 15.8 years). Forty-two patients received enemas, and 41 patients received gastrografin, with six dropouts in each group. Successful disimpaction was achieved with enemas (69.44%) and gastrografin (88.57%; P = 0.034), mean duration of impaction was strikingly different between the two groups (67.13 versus 31.67, respectively; P < 0.01). Constipation severity and symptom assessment were significantly reduced in the gastrografin group.
Gastrografin given through nasointestinal tube was more effective than enema in the treatment of FI inducing colon obstruction. Gastrografin might be taken into consideration as an effective and safe therapeutic option for FI.
背景/目的：粪便嵌塞（FI）是下消化道梗阻的常见原因。泛影葡胺是一种水溶性放射造影剂，可口服或直肠给药，已证实对粘连性小肠梗阻有治疗作用。长期以来，灌肠一直被认为是治疗FI的最佳方法。本研究的目的是证明肠内给予泛影葡胺在治疗导致肠梗阻的FI方面可能比灌肠更有效。
进行了一项双盲、对照和随机试验。参与者通过鼻肠管接受100毫升泛影葡胺（泛影葡胺组）或灌肠（灌肠组），每天一次，连续六天。评估粪便解嵌塞成功情况、FI缓解时间、布里斯托大便分类法、便秘严重程度、症状评估和不良事件。
共有124例患者符合条件，但只有83例纳入本试验（平均年龄：44±15.8岁）。42例患者接受灌肠，41例患者接受泛影葡胺，每组各有6例退出。灌肠组（69.44%）和泛影葡胺组（88.57%；P=0.034）均实现了解嵌塞成功，两组的平均嵌塞持续时间有显著差异（分别为67.13和31.67；P<0.01）。泛影葡胺组的便秘严重程度和症状评估显著降低。
通过鼻肠管给予泛影葡胺在治疗导致结肠梗阻的FI方面比灌肠更有效。泛影葡胺可被视为治疗FI的一种有效且安全的治疗选择。
