S1213 Comparisons and Outcomes of Early Treatment of Acute Colonic Pseudo-Obstruction

Introduction: The American Society for Gastrointestinal Endoscopy (ASGE) recommends conservative management—including nasogastric decompression, bowel rest, and correction of fluid and electrolyte imbalances—as the first-line treatment for acute colonic pseudo-obstruction (ACPO). Neostigmine is recommended if no clinical improvement occurs within 48 to 72 hours. However, the role of bowel regimens and enemas is not addressed in current guidelines. This study aims to evaluate the cumulative impact of non-invasive treatment strategies used at our institution. Methods: We conducted a retrospective review of patients with ACPO who received conservative and pharmacologic therapies at our institution. Patients were categorized based on treatment received within 72 hours of diagnosis into 3 groups: conservative management alone, conservative management with bowel regimens (laxatives or enemas), and conservative management with both bowel regimens and neostigmine. Pairwise comparisons were performed using chi-square and Kruskal-Wallis tests, with statistical significance defined as P < 0.05. Results: A total of 305 patients were included (70.8% male, n = 216). Early treatment distribution was as follows: conservative management alone (n = 81), conservative management with bowel regimens (n = 175), and conservative management with bowel regimens plus neostigmine (n = 49). The success rates for each group were 54.3%, 59.2%, and 65.7%, respectively, with no statistically significant differences among the treatment strategies (P = 0.203). The median time to clinical resolution was 2 days (IQR 1.25–3) in the conservative group, 3 days (IQR 1–5) in the bowel regimen group, and 3 days (IQR 2–5) in the neostigmine group (P = 0.282). Among patients initially managed with conservative therapy alone, 45.7% (n = 37) required treatment escalation to neostigmine after 72 hours. In this subgroup, the median time to resolution extended to 6 days (IQR 3–8.25), nearly twice the duration seen in those who received early neostigmine administration, preceding the guideline-defined threshold. Conclusion: Although early escalation to neostigmine did not significantly impact overall success rates, it was associated with a shorter time to clinical resolution, suggesting a potential benefit in expediting recovery. This may reduce hospitalization and patient discomfort. Further studies are warranted to better define the safety and outcomes of earlier intervention.