Acute Colonic Pseudo-obstruction: Colonoscopy Versus Neostigmine First?

Neostigmine (NEO) and decompressive colonoscopy (COL) are two efficacious treatment modalities for acute colonic pseudo-obstruction (ACPO). We hypothesize that a COL first strategy is associated with better outcomes compared to a NEO first strategy. A single-center retrospective analysis was perform...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of surgical research 2023-08, Vol.288, p.38-42
Main Authors: Williamson, Sigrid, Muller, Alison, Butts, Christopher A., Geng, Thomas A., Ong, Adrian W.
Format: Article
Language:English
Subjects:
Acute colonic pseudo-obstruction
Acute Disease
Colonic Pseudo-Obstruction - surgery
Colonic Pseudo-Obstruction - therapy
Colonoscopy
Decompressive colonoscopy
Humans
Neostigmine
Neostigmine - therapeutic use
Ogilvie's syndrome
Retrospective Studies
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Neostigmine (NEO) and decompressive colonoscopy (COL) are two efficacious treatment modalities for acute colonic pseudo-obstruction (ACPO). We hypothesize that a COL first strategy is associated with better outcomes compared to a NEO first strategy. A single-center retrospective analysis was performed from 2013 to 2020. Patients ≥18 y with a diagnosis of ACPO were included. The outcome was a composite measure of acute operative intervention, 30-day readmission with ACPO, and 30-day ACPO-related mortality. A P-value of ≤ 0.05 indicated statistical significance. Of 910 encounters in 849 patients, 50 (5.5%) episodes of ACPO in 39 patients were identified after exclusion of one patient with colon perforation on presentation. The median (interquartile range) age was 68 (62-84) y. NEO and COL were administered in 21 and 25 episodes, respectively. In 16 (32%) episodes, no NEO or COL was administered. When patients were given NEO first, COL or additional NEO was required in 12/18 (67%) compared with a COL first strategy where a second COL and/or NEO was given in 5/16 (32%) (P = 0.05). Both strategies had similar outcomes (NEO, 4/18 versus COL, 4/16, P = 0.85). Twenty-two (44%) episodes had an early intervention (≤48 h) with NEO and/or COL. There was no difference in outcome between those that received an early intervention and those who did not (5/22 versus 5/28, P = 0.71). For patients failing conservative measures, a COL first approach was associated with fewer subsequent interventions, but with similar composite outcomes compared to a NEO first approach. Early (≤48 h) intervention with NEO and/or COL was not associated with improved outcomes.
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2023.02.023