Acute Colonic Pseudo-obstruction: Colonoscopy Versus Neostigmine First?

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.