Small bowel obstruction (SBO) and its complications are frequently seen in patients admitted through the Emergency Departments of all acute care hospitals2.

There is variation in the optimal use of imaging, the appropriate timing and duration of non-operative management attempts, anti-microbial therapies, and the criteria for surgical management, which results in heterogeneity in approaches and outcomes across international clinical centers. The expected number of SBO cases in most clinical centers is predictable, enabling a suitably-sized cohort of patients to be gathered in the snapshot audit.

This 'ESTES snapshot audit' -a prospective observational cohort study- has a dual purpose. Firstly, as an epidemiological study, it aims to uncover the burden of disease. Secondly, it aims to demonstrate current strategies employed to diagnose and treat these patients. These twin aims will serve to provide a 'snapshot' of current practice, but will also be hypothesis-generating while providing a rich source of patient-level data to allow further analysis of the particular clinical questions.

Prospective audit of consecutive patients admitted in Emergency Department for mechanical small bowel obstruction over a 3-month period. The audit shall include unscheduled patient admissions from November 2023 until May 2024 as outlined in 'Key Study Dates'.

As this is an observational cohort audit, no change to normal patient management is required.

Primary Objective

To explore differences in patients, management and outcomes across the entire cohort to identify areas of practice variability resulting in apparent differences in outcome warranting further study. The outcomes that the study will examine are:

• Incidence of small bowel obstruction by etiology.
• Differences in clinical presentation.
• Diagnostic work-up.
• Non-operative management strategies.
• Time to surgery and outcomes.
• Complications related to disease and/or therapies within 60 post-operative days.
• Length of Emergency Department and Hospital stay.
• Re-admission within 6 months for related conditions.

Methods for identifying patients

Multiple methods may be used according to local circumstances/staffing:

1. Daily review of emergency department (non-operative) and operating room lists.
2. Daily review of team handover sheets / emergency admission lists / ward lists.
3. Review of operating room logbooks.
4. Use of electronic systems to flag any readmissions of patients identified and treated.

Inclusion Criteria:

• Adult patients (≥16 years of age) admitted for mechanical small bowel obstruction. Example etiologies which should be included:

  1. Adhesions.
  2. Hernias with bowel compromise (incisional/parastomal, ventral, inguinal, femoral, obturator, internal).
  3. Malignancy (primary: lymphoma, carcinoid, GIST, adenocarcinoma/metastatic disease: colon, ovarian, gastric, pancreatic, melanoma and others).
  4. Enteroliths/gallstones/bezoars/foreign bodies
  5. Radiation.
  6. Inflammation (Crohn's disease, mesenteric adenitis, appendicitis, diverticulitis, tuberculosis, actinomycosis, ascariasis).
  7. Congenital (malrotation, duplication cysts).
  8. Trauma (hematomas, ischemic strictures).

Exclusion Criteria:

• Functional small bowel obstruction (dysmotility or adynamic ileus secondary to abdominal operations, peritonitis, trauma or medications).

Adult patients (≥16 years of age) admitted for mechanical small bowel obstruction.

The ESTES SnapAppy Group welcomes the use of these de-identified pooled data for further research that benefits patients. Requests can be submitted to the ESTES Research Committee. Release is subject to their approval and the appropriate safeguarding as determined by applicable legislation (GDPR and HIPAA).

After study main conclusions are published

Being one of study participating centers investigators