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Related Experiment Video

Updated: Aug 6, 2025

Video Imaging and Spatiotemporal Maps to Analyze Gastrointestinal Motility in Mice
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Acute Colonic Pseudo-obstruction: Colonoscopy Versus Neostigmine First?

Sigrid Williamson1, Alison Muller1, Christopher A Butts1

  • 1Division of Trauma and Critical Care, Department of Surgery, Reading Hospital, Tower Health System, Reading, Pennsylvania.

The Journal of Surgical Research
|March 22, 2023
PubMed
Summary

A colonoscopy first strategy for acute colonic pseudo-obstruction (ACPO) may reduce subsequent interventions compared to neostigmine first. However, both approaches showed similar overall outcomes in this retrospective study.

Keywords:
Acute colonic pseudo-obstructionDecompressive colonoscopyNeostigmineOgilvie's syndrome

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Medical Interventions

Background:

  • Acute colonic pseudo-obstruction (ACPO) is a condition requiring effective treatment.
  • Neostigmine (NEO) and decompressive colonoscopy (COL) are established treatments for ACPO.

Purpose of the Study:

  • To compare the outcomes of a colonoscopy-first strategy versus a neostigmine-first strategy for ACPO.
  • To evaluate the impact of early intervention on ACPO outcomes.

Main Methods:

  • Retrospective analysis of 910 ACPO encounters (2013-2020).
  • Inclusion criteria: patients ≥18 years with ACPO diagnosis.
  • Primary outcome: composite of operative intervention, 30-day readmission, and 30-day ACPO-related mortality.

Main Results:

  • A colonoscopy-first strategy required fewer subsequent interventions (32%) compared to neostigmine-first (67%) (P=0.05).
  • Both strategies yielded similar composite outcomes (NEO-first: 4/18, COL-first: 4/16, P=0.85).
  • Early intervention (≤48 hours) did not significantly improve outcomes (5/22 vs. 5/28, P=0.71).

Conclusions:

  • For ACPO patients failing conservative measures, a colonoscopy-first approach may reduce the need for further interventions.
  • Colonoscopy-first and neostigmine-first strategies demonstrated comparable overall composite outcomes.
  • Early intervention within 48 hours for ACPO did not show a significant benefit in outcomes.