SBO article

Utilization of ultrasound for the evaluation of small bowel obstruction: A systematic review and meta-analysis.

Gottlieb M¹, Peksa GD², Pandurangadu AV², Nakitende D², Takhar S³, Seethala RR³.

Am J Emerg Med. 2018 Feb;36(2):234-242. doi: 10.1016/j.ajem.2017.07.085. Epub 2017 Jul 29.

Article Summary:

• SBO is a common presentation in the ED and CT is often used to confirm diagnosis. However, this modality is expensive, exposes patients to radiation, may lead to time delays, and is not universally available. Therefore, this study is conducted to determine the diagnostic accuracy of ultrasound to detect SBO.
• The reasons that I would choose this study are that it is a systematic review and meta-analysis, and it is published recently in 2018 by the American Journal of Emergency Medicine.
• 11 studies comprising 1178 total patients were included in the study. Overall, ultrasound was found to be 92.4% sensitive (95% CI 89.0% to 94.7%) and 96.6% specific (95% CI 88.4% to 99.1%) with a positive likelihood ratio of 27.5 (95% CI 7.7 to 98.4) and a negative likelihood ratio of 0.08 (95% CI 0.06 to 0.11).
• In conclusion, ultrasound is suggested to be a valuable tool in the diagnosis of SBO with a sensitivity and specificity comparable to that of CT. Ultrasound appears better than MRI and radiography. It may save time and radiation exposure, while also allowing for serial examination of patients to assess for resolution of the SBO. It can also be performed at bedside allowing for rapid diagnosis, consultation, and intervention. It is also beneficial in settings with limited or no access to CT.

• Limitations:
• All the studies included are prospective, observational studies. Lack of RCTs
• Difference in sonographer might also limited the data
• Limited data in the pediatric population

• Future studies:
• Larger patient groups
• More studies focused in the ED settings
• Comparisons of probe choices
• Inclusion of more pediatric patients.

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