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Endoscopic Management of Acute Colonic Obstruction and Pseudo-obstruction

  • Thomas C. Queen
  • Douglas G. AdlerEmail author

Abstract

In acute colonic pseudo-obstruction (ACPO), supportive management and medical treatment with neostigmine are initial mainstays of therapy. Colonoscopic decompression with tube placement provides reliable relief in patients who do not respond to medical therapy or have contraindications to the use of neostigmine. Advanced techniques, such as percutaneous endoscopic cecostomy or colostomy, are alternatives to tube decompression, although additional studies are needed to assess their safety and efficacy. Self-expanding metal stent placement for acute colonic obstruction (ACO) due to malignancy is indicated in a palliative setting or as a preoperative bridge until definitive surgery is feasible. Decompression tube placement and tumor debulking with endoscopic laser treatment are no longer first-line therapy for malignant ACO. Recent advances in endoscopic management of ACPO and MCO have reduced the need for emergent surgery, with high technical and clinical success rates and improved patient outcomes.

This chapter includes supplementary videos.

Keywords

Ogilvie’s syndrome Acute colonic pseudo-obstruction Colonic obstruction Colonoscopy Colonic stent Stents 

Supplementary material

Video 17.1

Self-expanding metal stent placement for acute colonic obstruction due to partially obstructing tumor (MP4 25364 kb)

Video 17.2

Self-expanding metal stent placement for acute colonic obstruction due to near-completely occluding tumor (MP4 69836 kb)

Video 17.3

Endoscopic management of sigmoid volvulus (MP4 30813 kb)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineHuntsman Cancer Center, University of Utah School of MedicineSalt Lake CityUSA

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