OBJECTIVE： To systematically evaluate th e ther apeutic effects of conservative treatment combined with water-soluble contrast agents for adhesive small bowel obstruction ，and to provide evidence-based reference for clinical medication. METHODS：Retrieved from Cochrane library ，PubMed，Embase，Wanfang database and CNKI during the inception to Sept. 2020，RCTs about conservative treatment combined with water-soluble contrast agents in the therapeutic efficacy for adhesive small bowel obstruction were collected. After literature screening and data extraction ，the quality of included literatures were evaluated with Cochrane system evaluator manual 5.1.0 and Jadad scale. Meta-analysis was conducted by using Rev Man 5.3 and Stata 16 software. RESULTS ：A total of 15 RCTs were included ，with 1 429 patients in total. Results of Meta-analysis showed that the use of water-soluble contrast agents significantly reduced the surgical needs of patients with adhesive small bowel obstruction [OR ＝ 0.64，95％CI（0.50，0.81），P＜0.001]；reduced the remission time of non-surgical patients [MD ＝－23.37， 95％CI（－32.17， －14.57），P＜0.001]，hospital stay days of non-surgical patients [MD ＝－2.21，95％CI（－2.52，－1.90），P＜0.001] and hospital stay days of all patients [MD ＝－2.43，95％CI（－3.93，－0.92），P＝0.002]，and would not increase the incidence of complications [OR ＝1.15，95％CI（0.63，2.10），P＝0.65]，but could not reduce mortality [OR ＝1.26，95％CI（0.94，3.24），P＝ 0.63] or the probability of bowel resection [OR ＝0.93，95％CI（0.57，1.52），P＝0.78]. CONCLUSIONS ：The combined use of water-soluble contrast agents for patients with adhesive small bowel obstruction is safe and effective ，can reduce the patient ’s surgical requirements ，and is beneficial to reduce the length of hospital stay and time for symptom relief.