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Oral water soluble contrast for malignant bowel obstruction

Appendices

Appendix 1. Search strategies

CENTRAL (CRSO)

("water soluble contrast"):TI,AB,KY

MESH DESCRIPTOR Contrast Media

MESH DESCRIPTOR Diatrizoate Meglumine

("water‐soluble contrast"):TI,AB,KY

("water‐soluble contrast"):TI,AB,KY

((gastrografin or urografin)):TI,AB,KY

((sodium diatrizoate or meglumine

diatrizoate)):TI,AB,KY

#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7

MESH DESCRIPTOR Intestinal Obstruction

EXPLODE ALL TREES

( ((bowel* or intestin*) adj3 (obstruct*

or block*))):TI,AB,KY

(((bowel* or intestin*) adj3 adhes*)):TI,AB,KY

#9 OR #10 OR #11

#8 AND #12

MEDLINE & MEDLINE in Process (OVID)

(N.B MEDLINE in Process was searched without the RCT filter)

1 "water soluble contrast".tw. (1055)

2 Contrast Media/ (67222)

3 Diatrizoate Meglumine/ (1980)

4 "water‐soluble contrast".tw. (1055)

5 (gastrografin or urografin).tw. (749)

6 (sodium diatrizoate or meglumine diatrizoate).tw. (475)

7 or/1‐6 (69062)

8 exp Intestinal Obstruction/ (38615)

9 ((bowel* or intestin*) adj3 (obstruct* or block*)).tw. (408)

10 ((bowel* or intestin*) adj3 adhes*).tw. (1684)

11 or/8‐10 (40137)

12 7 and 11 (738)

13 randomized controlled trial.pt. (382255)

14 controlled clinical trial.pt. (88491)

15 randomized.ab. (306631)

16 placebo.ab. (157203)

17 drug therapy.fs. (1728855)

18 randomly.ab. (222443)

19 trial.ab. (316184)

20 groups.ab. (1406392)

21 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 (3430383)

22 exp animals/ not humans.sh. (3974624)

23 21 not 22 (2944461)

24 12 and 23 (81)

Embase (OVID)

1 "water soluble contrast".tw. (1335)

2 Contrast Media/ (51233)

3 Diatrizoate Meglumine/ (3975)

4 "water‐soluble contrast".tw. (1335)

5 (gastrografin or urografin or amidotrizoato).tw. (2278)

6 (sodium diatrizoate or meglumine diatrizoate).tw. (560)

7 or/1‐6 (56082)

8 exp Intestinal Obstruction/ (65812)

9 ((bowel* or intestin*) adj3 (obstruct* or block*)).tw. (23938)

10 ((bowel* or intestin*) adj3 adhes*).tw. (2375)

11 or/8‐10 (72748)

12 7 and 11 (1087)

13 random$.tw. (1042367)

14 factorial$.tw. (26683)

15 crossover$.tw. (55638)

16 cross over$.tw. (24913)

17 cross‐over$.tw. (24913)

18 placebo$.tw. (230237)

19 (doubl$ adj blind$).tw. (163757)

20 (singl$ adj blind$).tw. (16959)

21 assign$.tw. (276849)

22 allocat$.tw. (99768)

23 volunteer$.tw. (201215)

24 Crossover Procedure/ (45359)

25 double‐blind procedure.tw. (229)

26 Randomized Controlled Trial/ (390745)

27 Single Blind Procedure/ (21228)

28 or/13‐27 (1638839)

29 (animal/ or nonhuman/) not human/ (4918012)

30 28 not 29 (1453787)

31 12 and 30 (52)

CINAHL

S21 S11 AND S20

S20 S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19

S19 (allocat* random*)

S18 (MH "Quantitative Studies")

S17 (MH "Placebos")

S16 placebo*

S15 (random* allocat*)

S14 (MH "Random Assignment")

S13 (Randomi?ed control* trial*)

S12 (singl* blind* ) or (doubl* blind* ) or (tripl* blind* ) or

(trebl* blind* ) or (trebl* mask* ) or

(tripl* mask* ) or (doubl* mask* ) or (singl* mask* )

S11 S6 AND S10

S10 S7 OR S8 OR S9

S9 ((bowel* or intestin*) N3 adhes*)

S8 ((bowel* or intestin*) N3 (obstruct* or block*))

S7 (MH "Intestinal Obstruction+")

S6 S1 OR S2 OR S3 OR S4 OR S5

S5 (sodium diatrizoate or meglumine diatrizoate)

S4 (gastrografin or urografin)

S3 "water‐soluble contrast".

S2 (MH "Contrast Media")

S1 "water soluble contrast".

Web of Science (ISI)

#16 #15 AND #11

# 15 #14 OR #13 OR #12

# 14 TS=((((singl* OR doubl* OR trebl*

OR tripl*) SAME (blind* OR mask*))))

#13 TS= (((controlled clinical trial OR

controlled trial OR clinical trial OR

placebo)))

#12 TS= (((randomised OR randomized OR

randomly OR random order OR random

sequence OR random allocation OR randomly

allocated OR at random OR randomized

controlled trial)))

#11 #10 AND #7

#10 #9 OR #8

#9 TOPIC: (((bowel* or intestin*) near/3

adhes*))

#8 TS=(((bowel* or intestin*) near/3

(obstruct* or block*)))

#7 #6 OR #5 OR #4 OR #3 OR #2 OR #1

#6 TOPIC: ((sodium diatrizoate or

meglumine diatrizoate))

#5 TOPIC: ((gastrografin or urografin))

#4 TOPIC: ("water‐soluble contrast")

#3 TOPIC: (Diatrizoate Meglumine)

#2 TOPIC: ("Contrast Media")

#1 TOPIC: ("water soluble contrast")

Study flow diagram.

Figuras y tablas -
Figure 1

Study flow diagram.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Figuras y tablas -
Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Summary of findings 1. Summary of findings

Oral Water Soluble Contrast compared with Placebo for Malignant Bowel Obstruction

Patient or population: Adults 18 yrs and over with malignant bowel obstruction (MBO) as defined by the International Conference on MBO, with no indication for other treatments e.g. surgery, endoscopy, etc

Settings: Hospital inpatients

Intervention: 100 mL of gastrografin administered orally

Comparison: Placebo (100m L of distilled water flavoured with aniseed oil in order to mimic the taste and smell of gastrografin)

Outcomes

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

1. The ability of OWSC, when seen to reach the colon on follow‐up imaging, to predict the likelihood of malignant small bowel obstruction resolving with conservative treatment alone (diagnostic).

no data

no data

no data

2. The rate of resolution of MBO with medical management only in patients receiving OWSC compared with those not receiving it (therapeutic).

no data

no data

no data

3. Gastrointestinal adverse effects (increased abdominal pain, nausea, vomiting).

9

(1)

⊕⊝⊝⊝
very low1

Although they reported that "no issues regarding safety or tolerability of either gastrografin or placebo were identified", no data were actually reported.

4. Extra‐abdominal complications (aspiration pneumonia, hypersensitivity reactions).

9

(1)

⊕⊝⊝⊝
very low1

Although they reported that "no issues regarding safety or tolerability of either gastrografin or placebo were identified", no data were actually reported.

5. Length of hospital stay.

no data

no data

no data

6. Time from administration of OWSC to resolution of MBO.

no data

no data

no data

7. Survival time from onset of inoperable MBO until death.

no data

no data

no data

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect;
Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different;
Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect;
Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

1 Downgraded twice for serious limitations to study quality (high risk of selective reporting and of attrition bias) and downgraded once for imprecision (sparse data).

OWSC = oral water soluble contrast
Figuras y tablas -
Summary of findings 1. Summary of findings
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