From the Guidelines
Small bowel follow-through (SBFT) is not a treatment for ileus, but rather a diagnostic tool to help identify the underlying cause. The primary goal in managing ileus is to address the underlying cause, maintain hydration, and prevent complications. According to the most recent guidelines, optimization of fluid management, opioid-sparing analgesia, and early mobilization are key components in preventing postoperative ileus 1. In patients who present with ileus, early oral intake should be encouraged to maintain intestinal function, and small portions should be offered initially, especially after right-sided resections and small-bowel anastomosis 1. Some key points to consider in the management of ileus include:
- Bowel rest (nothing by mouth) to reduce the workload on the intestines
- Intravenous fluids to maintain hydration
- Nasogastric tube placement to decompress the stomach
- Correction of any electrolyte abnormalities
- Addressing the underlying cause of the ileus
- Medications that may help stimulate bowel motility, such as metoclopramide, erythromycin, or alvimopan, may be considered in certain cases
- Early ambulation is also encouraged when possible It's worth noting that while SBFT can be valuable in diagnosing the underlying cause of persistent ileus, it does not provide therapeutic benefit 1. Resolution of ileus typically occurs when the underlying cause is addressed and normal peristalsis returns.
From the FDA Drug Label
Metoclopramide Injection, USP may be used to stimulate gastric emptying and intestinal transit of barium in cases where delayed emptying interferes with radiological examination of the stomach and/or small intestine. The answer to whether Sbft (likely referring to a small bowel follow-through, a type of radiological examination) can help correct ileus is not directly addressed in terms of "correcting" ileus. However, metoclopramide can help stimulate intestinal transit, which might be beneficial in the context of ileus by potentially aiding in the movement of contents through the small bowel.
- Key point: The drug label supports the use of metoclopramide to stimulate gastric emptying and intestinal transit.
- Clinical decision: Metoclopramide may be used to aid in the management of conditions associated with delayed intestinal transit, such as ileus, by stimulating movement, but it does not directly "correct" ileus as the term might imply a resolution of the underlying cause. 2
From the Research
Sbft and Ileus Correction
- There is no direct evidence in the provided studies that suggests Sbft can help correct ileus.
- However, studies have shown that other interventions such as early enteral nutrition (EEN) 3, alvimopan 4, 5, and a standardized accelerated postoperative care pathway can help expedite the resolution of ileus.
- Metoclopramide has been shown to be ineffective in reducing the length of ileus after colorectal surgery 6 and in expediting the resolution of ileus in adult surgical patients 3.
- A modified water-soluble follow-through (SBFT) has been shown to be a useful tool in the diagnosis and management of small bowel obstruction, but its effectiveness in correcting ileus is not directly addressed 7.
- Alvimopan has been shown to accelerate gastrointestinal tract recovery, reduce postoperative ileus-related morbidity, and decrease hospital length of stay in patients undergoing bowel resection 4, 5.