Management of Ogilvie's Syndrome: A Network Meta-Analysis

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Clinical Trials & Meta-Analysis

Background:

• Ogilvie's syndrome (acute colonic pseudo-obstruction) involves acute colonic dilation without mechanical blockage.
• Prompt management is crucial to prevent ischemia and perforation.
• Current treatments include supportive care, neostigmine, and colonoscopic decompression.

Purpose of the Study:

• To compare the effectiveness of different interventions for Ogilvie's syndrome symptom resolution.
• To rank treatment strategies using a network meta-analysis.

Main Methods:

• Systematic literature search across multiple databases and grey literature.
• Inclusion of prospective cohort and case-control studies.
• Random-effects network meta-analysis with odds ratios and surface under the cumulative ranking curve (SUCRA) for ranking.

Main Results:

• Four studies with 172 patients were analyzed.
• Supportive care with neostigmine showed higher symptom resolution odds (OR 13.86) versus supportive care alone.
• Supportive care with colonoscopic decompression demonstrated superior efficacy (OR 65.65) and was ranked highest by SUCRA.

Conclusions:

• Active interventions, especially colonoscopic decompression or neostigmine combined with supportive care, significantly increase symptom resolution.
• These active strategies are more effective than supportive care alone for Ogilvie's syndrome.
• Further large-scale comparative studies are necessary to confirm findings and guide treatment decisions.