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Journal of Radiation Research Jan 2022Oral administration of a water-soluble iodine contrast agent (gastrografin) was reported to assist in the appropriate contouring of the small intestine on computed...
Oral administration of a water-soluble iodine contrast agent (gastrografin) was reported to assist in the appropriate contouring of the small intestine on computed tomography (CT)-based radiotherapy (RT) planning. The efficacy and optimal dose of gastrografin in CT-based image-guided brachytherapy (IGBT) for cervical cancer remain unknown. This study aimed to investigate the efficacy of pretreatment oral administration of gastrografin at a small dose of 50 ml in CT-based IGBT for cervical cancer. A total of 422 sessions in 137 patients who underwent CT-based IGBT with 50 ml of oral gastrografin (concentration, 3% or 4%) were analyzed. Preparation of gastrografin was judged as effective when the small intestine was contrast-enhanced at the area where the small intestine was in contact with the uterus/adnexa. About 287 out of 422 sessions (68%) were judged as effective with gastrografin preparation. The 135 ineffective sessions were considered as follows: (i) the contrast enhancement of the small intestine was not confirmed (n = 36), (ii) the small intestine was not in contact with the uterus/adnexa despite the confirmation of the contrast enhancement of the small intestine (n = 34), and (iii) gastrografin was absent in the small intestine at the area in contact with the uterus/adnexa, even when gastrografin was observed in the small intestine at the area not in contact with the uterus/adnexa (n = 65). In conclusion, pretreatment oral administration of a small dose gastrografin achieved moderate efficacy for accurate contouring of the small intestine close to the uterus/adnexa in CT-based IGBT for cervical cancer.
Topics: Brachytherapy; Contrast Media; Diatrizoate Meglumine; Female; Humans; Tomography, X-Ray Computed; Uterine Cervical Neoplasms
PubMed: 34718687
DOI: 10.1093/jrr/rrab102 -
American Journal of Surgery Dec 2019Differentiation between SBO that will resolve with supportive measures and those requiring surgery remains challenging. WSC administration may be diagnostic and... (Clinical Trial)
Clinical Trial
Differentiation between SBO that will resolve with supportive measures and those requiring surgery remains challenging. WSC administration may be diagnostic and therapeutic. The purpose of this study was to evaluate use of a SBO protocol using WSC challenge. A protocol was implemented at five tertiary care centers. Demographics, prior surgical history, time to operation, complications, and LOS were analyzed. 283 patients were admitted with SBO; 13% underwent immediate laparotomy; these patients had a median LOS of 7.5 days. The remaining 245 were candidates for WSC challenge. Of those, 80% received contrast. 139 (71%) had contrast passage to the colon. LOS in these patients was 4 days. Sixty-five patients (29%) failed contrast passage within 24 h and underwent surgery. LOS was 9 days. 8% of patients in whom contrast passage was observed at 24 h nevertheless subsequently underwent surgery. 4% of patients who failed WSC challenge did not proceed to surgery. Our multicenter trial revealed that implementation of a WSC protocol may facilitate early recognition of partial from complete obstruction.
Topics: Adult; Contrast Media; Diatrizoate Meglumine; Female; Humans; Intestinal Obstruction; Intestine, Small; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 31623878
DOI: 10.1016/j.amjsurg.2019.09.031 -
Journal of Gastroenterology Sep 2020Gastrointestinal decompression is generally applied to a non-strangulated acute small bowel obstruction (NSASBO). Although long tube (LT) placement and administration of... (Comparative Study)
Comparative Study Randomized Controlled Trial
The first management using intubation of a nasogastric tube with Gastrografin enterography or long tube for non-strangulated acute small bowel obstruction: a multicenter, randomized controlled trial.
BACKGROUND
Gastrointestinal decompression is generally applied to a non-strangulated acute small bowel obstruction (NSASBO). Although long tube (LT) placement and administration of Gastrografin through a nasogastric tube (NGT-G) have shown advantages over NGT alone in previous studies, no studies appear to have compared LT and NGT-G.
METHODS
In this multicenter, randomized controlled trial, patients with NSASBO were randomly assigned to receive LT or NGT-G between July 2016 and November 2018 at 11 Japanese institutions. The primary endpoint was non-inferiority of NGT-G compared to LT for non-surgery rate, and the lower limit of the 95% confidence interval for the non-surgery rate (-15%) was set as the lower margin for inferiority of NGT-G compared to LT.
RESULTS
In total, 223 patients (LT group, n = 111; NGT-G group, n = 112) were analyzed in the present trial. The non-surgery rate was 87.4% in the LT group and 91.1% in the NGT-G group, with a 3.7% difference between NGT-G and LT (95.3%CI - 5.55 to 12.91; non-inferiority P = 0.00002923). On the other hand, the non-surgery rate with pure NGT-G alone (76.8%) that represents non-cross-over NGT-G without subsequent LT was significantly lower than that with LT (P = 0.039). Median procedure time was significantly shorter with NGT-G (1 min) than with LT (25 min; P < 0.001), whereas no significant differences in mortality or hospital stay were noted between groups.
CONCLUSION
NGT-G is an effective alternative to LT as a first-line treatment for NSASBO. A sequential strategy comprising NGT-G followed by LT might offer a new standard for NSASBO.
CLINICAL TRIALS REGISTRATION
This trial was registered with the University Hospital Medical Information Network Clinical Trials Registry (umin.ac.jp/ctr Identifier: UMIN000022669) prior to the start of this trial.
Topics: Aged; Aged, 80 and over; Contrast Media; Diatrizoate Meglumine; Female; Humans; Intestinal Obstruction; Intestine, Small; Intubation, Gastrointestinal; Male; Middle Aged; Prospective Studies; Radiography
PubMed: 32671536
DOI: 10.1007/s00535-020-01708-5 -
Journal of Cystic Fibrosis : Official... Nov 2019
Topics: Adult; Constipation; Contrast Media; Cystic Fibrosis; Diatrizoate Meglumine; Duration of Therapy; Exocrine Pancreatic Insufficiency; Female; Gastrointestinal Motility; Humans; Hyperthyroidism; Intestinal Obstruction; Lung Transplantation; Male; Postoperative Complications; Radionuclide Imaging; Thyroid Function Tests; Withholding Treatment
PubMed: 31129069
DOI: 10.1016/j.jcf.2019.05.011 -
Abdominal Radiology (New York) Apr 2020Routine low dose non-contrast CT of the abdomen and pelvis has been suggested prior to same day completion CT colonography (CTC) to assess for occult perforation at...
PURPOSE
Routine low dose non-contrast CT of the abdomen and pelvis has been suggested prior to same day completion CT colonography (CTC) to assess for occult perforation at preceding incomplete colonoscopy, before further gaseous insufflation at CTC. The aim of our study is to examine the incidence of clinically significant perforation at low dose CT. We also examine the benefits of low dose pre-scan in assessing adequacy of bowel preparation and identifying any other relevant contraindications to CT colonography.
MATERIALS AND METHODS
We conducted a retrospective review of all low dose non-contrast CTs performed following failed colonoscopies over a 4-year period (n = 392). We also assessed the adequacy of bowel preparation on a scale of 1-5, in order of increasingly adequate preparation. Incidentally noted bowel pathology and contraindications to CT colonography were also recorded.
RESULTS
No perforation was identified either prospectively or in the course of our retrospective review. However, 15 patients (3.8%) were found to have potential contraindications to CT colonography, including: acute diverticulitis, acute colitis, and poor bowel preparation. Overall, the bowel preparation was felt to be adequate (≥ 3) in 86% percent of patients. Two patients (0.5%) identified prospectively had their CT colonography postponed due to poor bowel preparation.
Topics: Adult; Aged; Colon; Colonography, Computed Tomographic; Colonoscopy; Contrast Media; Diatrizoate Meglumine; Female; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Risk Factors
PubMed: 31123769
DOI: 10.1007/s00261-019-02062-8 -
Abdominal Radiology (New York) Apr 2020To assess the frequency and indications for use of oral water-soluble contrast challenge as a diagnostic test for small bowel obstruction in four regions of the USA.
OBJECTIVE
To assess the frequency and indications for use of oral water-soluble contrast challenge as a diagnostic test for small bowel obstruction in four regions of the USA.
MATERIALS AND METHODS
We distributed a 9-question web-based survey to the abdominal section heads of academic radiology departments throughout the USA (N = 97). The questions pertained to use of water-soluble contrast for management of small bowel obstruction. Descriptive statistics and Fisher's exact tests were used for data analysis.
RESULTS
The overall response rate was 46%. Eighty percent of the responding hospitals had more than 500 beds in operation. Water-soluble contrast challenge was considered standard of care for management of non-operative small bowel obstruction in 60% of the responding radiology departments. The majority of the responding departments (41%) performed 2-8 contrast challenge studies per month on average. The most frequent indication for the study was distinguishing partial vs complete bowel obstruction. Eighty percent of the responding radiologists believed that the contrast challenge is useful for management of small bowel obstruction. Overall, there was no statistically significant difference in frequency and indication for use of water-soluble contrast challenge based on geographic location.
CONCLUSION
The water-soluble contrast challenge was considered standard of care for non-operative management of small bowel obstruction in majority of the academic radiology departments represented in this survey. Surgeons were referring clinicians in every case. The most common clinical indication for the study was distinguishing partial versus complete small bowel obstruction.
Topics: Administration, Oral; Contrast Media; Diatrizoate Meglumine; Humans; Intestinal Obstruction; Intestine, Small; Practice Patterns, Physicians'; Surveys and Questionnaires; United States
PubMed: 32052131
DOI: 10.1007/s00261-020-02436-3 -
Lancet (London, England) Oct 2019
Topics: Animals; Anthelmintics; Diatrizoate Meglumine; Diphyllobothriasis; Diphyllobothrium; Female; Humans; Intestinal Diseases, Parasitic; Praziquantel; Ultrasonography; Young Adult
PubMed: 31591983
DOI: 10.1016/S0140-6736(19)32132-4 -
ANZ Journal of Surgery Oct 2019
Topics: Aged; Diatrizoate Meglumine; Female; Fundoplication; Gastric Outlet Obstruction; Humans; Laparoscopy; Tissue Adhesions; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30192052
DOI: 10.1111/ans.14781