Effectiveness of an Oral Gastrografin Regimen for Complete Distal Intestinal Obstruction Syndrome

Hugh L Giddings; Jared McNeill; Bayzidur Rahman; Alan P Meagher; Rohan Gett; Reginald V Lord

doi:10.1097/AS9.0000000000000279

Effectiveness of an Oral Gastrografin Regimen for Complete Distal Intestinal Obstruction Syndrome

Ann Surg Open. 2023 Apr 26;4(2):e279. doi: 10.1097/AS9.0000000000000279. eCollection 2023 Jun.

Authors

Hugh L Giddings^{1

2}, Jared McNeill¹, Bayzidur Rahman^{3

4}, Alan P Meagher^{1

2}, Rohan Gett^{1

5}, Reginald V Lord^{1

2

6}

Affiliations

¹ From the Department of General Surgery, St Vincent's Hospital, Sydney, Australia.
² Department of Surgery, School of Medicine, University of Notre Dame Australia, Sydney, Australia.
³ Department of Epidemiology and Biostatistics, School of Medicine, University of Notre Dame Australia, Sydney, Australia.
⁴ The Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Australia.
⁵ Department of Surgery, School of Medicine, UNSW Australia, Sydney, Australia.
⁶ St. Vincent's Centre for Applied Medical Research, Sydney, Australia.

Abstract

Objectives: To assess the effectiveness of oral Gastrografin treatment and outcomes in adult patients with complete distal intestinal obstruction syndrome (cDIOS).

Background: DIOS is an important gastrointestinal complication of cystic fibrosis (CF). Conservative treatment options for cDIOS are largely empirical, and the optimal management remains unclear. Surgery should be reserved for patients who have failed nonoperative treatment or have immediate indications for surgery.

Methods: A retrospective single-institution cohort study was undertaken of adults with CF who had undergone lung transplantation and were admitted with an episode of cDIOS between 2004 and 2020. The outcomes of treatment in a high-volume CF transplant center with routine oral Gastrografin-based therapy were assessed.

Results: Forty-seven episodes of cDIOS were recorded in 29 (23.3%) of 124 patients who had undergone lung transplantation for CF, and mean age at cDIOS was 30.3 years (SD ±11.2). Mean follow-up post cDIOS was 75.6 months (SD ±45.5). Twelve patients had >1 cDIOS episode. One episode occurred during recovery after transplantation, and 5 patients were readmitted within 30 days posttransplant with cDIOS. A history of previous abdominal surgery was associated with the development of cDIOS (P < 0.001). Oral Gastrografin therapy was used in 95.7% of the episodes, at varying doses. Three patients (7.0%) were resistant to oral Gastrografin treatment, requiring laparotomy. There were no deaths due to DIOS.

Conclusions: Oral Gastrografin is effective and safe for the treatment of cDIOS, with low treatment failure rates. It should be considered as a first-line treatment option for patients with CF presenting with complete distal intestinal obstruction.

Keywords: DIOS; complete; cystic fibrosis; distal intestinal obstruction syndrome; gastrografin.