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

Background/Objectives: Ogilvie's syndrome, or acute colonic pseudo-obstruction (ACPO), is defined by acute colonic dilatation without mechanical obstruction and carries a risk of ischemia and perforation if not promptly managed. Treatment strategies include conservative supportive care, neostigmine administration, colonoscopic decompression, and combinations of these approaches. The aim of this study was to compare the relative effectiveness of these interventions for symptom resolution using a network meta-analysis. Methods: A systematic search of PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and grey literature was conducted from inception in February 2025 to November 2025. Prospective cohort and case-control studies evaluating conservative supportive care, neostigmine, colonoscopic decompression, or their combinations were included. A random-effects network meta-analysis was performed using odds ratios (ORs) with 95% confidence intervals (CIs). Treatment ranking was assessed using surface under the cumulative ranking curve (SUCRA) values. Risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS). Results: Four studies comprising 172 patients were included. Compared with supportive care alone, supportive care combined with neostigmine was associated with higher odds of symptom resolution (network OR 13.86, 95% CI 3.06-62.83). Supportive care combined with colonoscopic decompression demonstrated an even greater effect (network OR 65.65, 95% CI 11.70-368.50). Colonoscopic decompression versus neostigmine yielded a network OR of 4.74 (95% CI 1.17-19.25). SUCRA rankings indicated that colonoscopic decompression combined with supportive care had the highest probability of being the most effective strategy. Conclusions: Active interventions, particularly colonoscopic decompression or neostigmine combined with supportive care, were associated with a higher incidence of symptom resolution compared to supportive care alone. Larger comparative studies are needed to confirm these findings and refine treatment selection.