Efficacy of Colonoscopic Decompression in the Management of Ogilvie Syndrome: A Systematic Review

Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), is characterized by massive dilation of the colon without any mechanical obstruction. This condition primarily affects elderly patients, particularly those who are hospitalized or have multiple comorbidities. The pathophysiology remains poorly understood, but it is believed to stem from an imbalance in the autonomic nervous system that disrupts normal colonic motility. ACPO can lead to significant complications, including colonic perforation, if not managed appropriately. Several treatment modalities are currently used for ACPO. Initially, conservative management is deployed, followed by endoscopic or medical intervention with neostigmine. Surgical colectomy or colostomy is offered as a last resort when other interventions either fail or are contraindicated. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we conducted a systematic literature search in PubMed/Medline, Europe PMC, Cochrane Library, Science Direct, EBSCO Open Dissertation, and ClinicalTrial.gov. A total of 12 studies were included in our review, with sample sizes ranging from one to 138 participants (a total of 387). The eligibility criteria focused on adults aged 18 and older who were diagnosed with Ogilvie syndrome, dilated colon with no physical bowel obstruction on imaging studies, and underwent colonoscopic decompression as a treatment. Colonoscopic decompression presents a promising intervention for Ogilvie syndrome, showing superior efficacy to neostigmine; however, relapses are common. The administration of polyethylene glycol (PEG) reduces relapses and improves the effectiveness of colonoscopic decompression. Future research should focus on larger randomized controlled trials (RCTs) to validate these findings, address existing gaps, and explore long-term outcomes.