Skip to main content
SpringerLink
Log in

Colonoscopic decompression should be used before neostigmine in the treatment of Ogilvie’s syndrome

European Journal of Trauma and Emergency Surgery volume 43, pages 557–566 (2017)Cite this article

Abstract

Background

Performance of urgent colonoscopy for the purposes of diagnosis and treatment of Ogilvie’s syndrome remains controversial. However, no trials have directly compared neostigmine with endoscopic therapy. This study aimed to compare the effect of neostigmine and colonoscopic decompression in the treatment of Ogilvie’s syndrome.

Methods

This study was designed as a retrospective, non-randomized clinical study of sequential patients. Patients who were diagnosed as having acute colonic pseudo-obstruction were separated into two groups after conservative treatment. Group 1 comprised patients who underwent colonoscopic decompression, because they had a poor first response to neostigmine treatment. Group 2 constituted patients who had a poor first response to colonoscopic decompression, and neostigmine was added to the treatment regimen. Groups 1 and 2 were compared for the success of disease management.

Results

In groups 1 and 2, the average age of the patients was 63.19 years (±14.71 years) and 59.45 years (±15.31 years) (p = 0.312), respectively. No significant difference was determined between the groups in terms of distribution of sex, hospital stay, etiologies, and initial cecal sizes in imaging (p > 0.05). Response to first intervention was statistically significant (p < 0.01). Also, the total response was determined statistically significant for hospital stay if colonoscopic decompression was performed (p < 0.01). No recurrence was determined during the 1-month follow-up in both groups. Although there was no etiologic factor for neostigmine response according to univariate analysis results, colonoscopic success was decreased due to age, sex, and the presence of a cardiac disease.

Conclusions

Although the success rate of neostigmine treatment was significantly lower in our homogeneous groups, no significant decrease was determined in terms of hospital stay, intensive care unit stay, and requirement of colostomy compared with colonoscopic decompression. By comparison, colonoscopic decompression, which was performed by experienced endoscopists as a first-line treatment option, was more effective as an initial therapy and was more effective at avoiding a second treatment modality.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

Abbreviations

PEG:

Polyethylene glycol

ASGE:

American Society for Gastrointestinal Endoscopy

ACPO:

Acute colonic pseudo-obstruction

References

  1. Saunders MD, Kimmey MB. Systematic review: acute colonic pseudo-obstruction. Aliment Pharmacol Ther. 2005;22:917–25.

    Article  CAS  PubMed  Google Scholar 

  2. Meier-Ruge W, Hunziker O. Extrinsic parasympathetic innervation of the distal colon. Abdom Surg. 1974;16:139.

    Google Scholar 

  3. Ben Ameur H, Boujelbene S, Beyrouti MI. Treatment of acute colonic pseudo-obstruction (Ogilvie's Syndrome). Systematic review. Tunis Med. 2013;91(10):565–72.

  4. Tack J. Acute colonic pseudo-obstruction (Ogilvie’s syndrome). Curr Treat Options Gastroenterol. 2006;9:361–8.

    Article  PubMed  Google Scholar 

  5. ASGE Standards of Practice Committee, Harrison ME, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, Cash BD, Fanelli RD, Fisher L, Fukami N, Gan SI, Ikenberry SO, Jain R, Khan K, Krinsky ML, Maple JT, Shen B, Van Guilder T, Baron TH, Dominitz JA. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc. 2010;71(4):669–79.

    Article  Google Scholar 

  6. Saunders MD. Acute colonic pseudo-obstruction. Best Pract Res Clin Gastroenterol. 2007;21:671–87.

    Article  PubMed  Google Scholar 

  7. Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilivie’s syndrome). An analysis of 400 cases. Dis Colon Rectum. 1986;29:203–10.

    Article  CAS  PubMed  Google Scholar 

  8. Batke M, Cappell MS. Adynamic ileus and acute colonic pseudo-obstruction. Med Clin North Am. 2008;92(3):649–70.

    Article  PubMed  Google Scholar 

  9. Sloyer AF, Panella VS, Demas BE, Shike M, Lightdale CJ, Winawer SJ, Kurtz RC. Ogilvie’s syndrome Successful management without colonoscopy. Dig Dis Sci. 1988;33:1391–6.

    Article  CAS  PubMed  Google Scholar 

  10. Kukora JS, Dent TL. Colonoscopic decompression of massive nonobstructive cecal dilation. Arch Surg. 1977;112(4):512–7.

    Article  CAS  PubMed  Google Scholar 

  11. Jain A, Vargas HD. Advances and challenges in the management of acute colonic pseudo-obstruction (Ogilvie syndrome). Clin Colon Rectal Surg. 2012;25(1):37–45.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Geller A, Petersen BT, Gostout CJ. Endoscopic decompression for acute colonic pseudo-obstruction. Gastrointest Endosc. 1996;44:144–50.

    Article  CAS  PubMed  Google Scholar 

  13. Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, Lieb JG II, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Wani S, Weinberg DS. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81:31–53.

    Article  PubMed  Google Scholar 

  14. Jain A, Vargas HD. Advances and challenges in the management of acute colonic pseudo-obstruction (Ogilvie syndrome). Clin Colon Rectal Surg. 2012;25:37–45.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Smart CJ, Ramesh AN. The successful treatment of acute refractory pseudo obstruction with prucalopride. Colorectal Dis. 2012;14:e508.

    Article  CAS  PubMed  Google Scholar 

  16. Mehta R, John A, Nair P, Raj VV, Mustafa CP, Suvarna D, Balakrishnan V. Factors predicting successful outcome following neostigmine therapy in acute colonic pseudo-obstruction: a prospective study. J Gastroenterol Hepatol. 2006;21:459–61.

    Article  CAS  PubMed  Google Scholar 

  17. Loftus CG, Harewood GC, Baron TH. Assessment of predictors of response to neostigmine for acute colonic pseudo-obstruction. Am J Gastroenterol. 2002;97:3118–22.

    Article  CAS  PubMed  Google Scholar 

  18. Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med. 1999;341:137–41.

    Article  CAS  PubMed  Google Scholar 

  19. Abeyta BJ, Albrecht RM, Schermer CR. Retrospective study of neostigmine for the treatment of acute colonic pseudo-obstruction. Am Surg. 2001;67:265–8.

    CAS  PubMed  Google Scholar 

  20. Beattie GC, Peters RT, Guy S, Mendelson RM. Computed tomography in the assessment of suspected large bowel obstruction. ANZ J Surg. 2007;77:160–5.

    Article  PubMed  Google Scholar 

  21. Tsirline VB, Zemlyak AY, Avery MJ, Colavita PD, Christmas AB, Heniford BT, Sing RF. Colonoscopy is superior to neostigmine in the treatment of Ogilvie’s syndrome. Am J Surg. 2012;204(6):849–55 (discussion 855).

    Article  CAS  PubMed  Google Scholar 

  22. Fausel CS, Goff JS. Nonoperative management of acute idiopathic colonic pseudo-obstruction (Ogilvie’s syndrome). West J Med. 1985;143:50–4.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We would like to thank Mr. David F. Chapman for his assistance with the language in the manuscript.

Author information

Authors and Affiliations

  1. Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey

    K. D. Peker, M. Cikot, M. A. Bozkurt, B. Kankaya, S. Binboga, H. Seyit & H. Alis

  2. Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey

    B. Ilhan

Authors
  1. K. D. Peker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Cikot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. A. Bozkurt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Ilhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Kankaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Binboga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H. Seyit
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H. Alis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. D. Peker.

Ethics declarations

Ethics committee approval was received for this study from the ethics committee of Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey (Decision No.: 168; Date: 02.08.2014).

Conflict of interest

Kivanc Derya Peker, Murat Cikot, Mehmet Abdussamet Bozkurt, Burak Ilhan, Burak Kankaya, Sinan Binboga, Hakan Seyit and Halil Alis declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peker, K.D., Cikot, M., Bozkurt, M.A. et al. Colonoscopic decompression should be used before neostigmine in the treatment of Ogilvie’s syndrome. Eur J Trauma Emerg Surg 43, 557–566 (2017). https://doi.org/10.1007/s00068-016-0709-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-016-0709-y

Keywords

search

Navigation