From the Guidelines
A Gastrographin challenge is recommended as a diagnostic tool for suspected small-bowel obstruction, involving the administration of 100 mL of a hyperosmolar iodinated contrast agent, with follow-up radiographs at 8 and 24 hours to predict the success of conservative measures. The protocol, as described in the study by 1, involves oral or enteric tube administration of the contrast agent, which helps to differentiate partial or low-grade SBO from a complete or high-grade SBO. The key benefit of this approach is that patients in whom contrast reaches the colon by 24 hours rarely require surgery. Some key considerations for the Gastrographin challenge include:
- The use of a hyperosmolar iodinated contrast agent, such as diatrizoate meglumine and diatrizoate sodium, diluted in 50 mL of water
- Follow-up radiographs performed at 8 and 24 hours after ingestion to track the contrast medium's progression
- The procedure's ability to predict the need for surgical intervention, with patients who have contrast reach the colon by 24 hours being less likely to require surgery, as noted in the study by 1 The Gastrographin challenge is a valuable diagnostic tool in the management of suspected small-bowel obstruction, and its use can help guide treatment decisions and improve patient outcomes, as supported by the evidence from 1.
From the FDA Drug Label
Gastrografin (Diatrizoate Meglumine and Diatrizoate Sodium Solution) is indicated for radiographic examination of segments of the gastrointestinal tract (esophagus, stomach, proximal small intestine, and colon). The Gastrographin challenge is not directly mentioned in the provided drug label.
- The label discusses the indications and usage of Gastrografin for radiographic examination of the gastrointestinal tract.
- It does not provide information on the Gastrographin challenge. 2
From the Research
Gastrographin Challenge Overview
- The Gastrografin (GG) challenge is a diagnostic and therapeutic tool used to treat patients with small bowel obstruction (SBO) 3, 4, 5, 6, 7.
- It involves enteric administration of a water-soluble contrast followed by serial abdominal radiographs 4.
Safety and Efficacy
- The GG challenge has been shown to be safe and effective in patients presenting with SBO and a history of abdominal or pelvic malignancy 3.
- There were no adverse events related to GG administration in one study 3.
- The GG challenge can reduce the need for operative exploration and improve patient outcomes 3, 7.
Comparison to Traditional Management
- The GG challenge has been compared to traditional management of SBO, with similar long-term recurrence rates 5.
- One study found that the GG challenge reduced the need for surgery and shortened hospital length of stay compared to off-protocol patients 7.
Specific Patient Populations
- The GG challenge has been studied in patients with a history of abdominal or pelvic malignancy, with positive outcomes 3.
- It has also been used in patients with early postoperative small bowel obstruction, with no difference in operative re-exploration rates but a longer hospital duration of stay 6.