Abstract：
Neostigmine (NEO) and decompressive colonoscopy (COL) are two efficacious treatment modalities for acute colonic pseudo-obstruction (ACPO). We hypothesize that a COL first strategy is associated with better outcomes compared to a NEO first strategy.
A single-center retrospective analysis was performed from 2013 to 2020. Patients ≥18 y with a diagnosis of ACPO were included. The outcome was a composite measure of acute operative intervention, 30-day readmission with ACPO, and 30-day ACPO-related mortality. A P-value of ≤ 0.05 indicated statistical significance.
Of 910 encounters in 849 patients, 50 (5.5%) episodes of ACPO in 39 patients were identified after exclusion of one patient with colon perforation on presentation. The median (interquartile range) age was 68 (62-84) y. NEO and COL were administered in 21 and 25 episodes, respectively. In 16 (32%) episodes, no NEO or COL was administered. When patients were given NEO first, COL or additional NEO was required in 12/18 (67%) compared with a COL first strategy where a second COL and/or NEO was given in 5/16 (32%) (P = 0.05). Both strategies had similar outcomes (NEO, 4/18 versus COL, 4/16, P = 0.85). Twenty-two (44%) episodes had an early intervention (≤48 h) with NEO and/or COL. There was no difference in outcome between those that received an early intervention and those who did not (5/22 versus 5/28, P = 0.71).
For patients failing conservative measures, a COL first approach was associated with fewer subsequent interventions, but with similar composite outcomes compared to a NEO first approach. Early (≤48 h) intervention with NEO and/or COL was not associated with improved outcomes.
A single-center retrospective analysis was performed from 2013 to 2020. Patients ≥18 y with a diagnosis of ACPO were included. The outcome was a composite measure of acute operative intervention, 30-day readmission with ACPO, and 30-day ACPO-related mortality. A P-value of ≤ 0.05 indicated statistical significance.
Of 910 encounters in 849 patients, 50 (5.5%) episodes of ACPO in 39 patients were identified after exclusion of one patient with colon perforation on presentation. The median (interquartile range) age was 68 (62-84) y. NEO and COL were administered in 21 and 25 episodes, respectively. In 16 (32%) episodes, no NEO or COL was administered. When patients were given NEO first, COL or additional NEO was required in 12/18 (67%) compared with a COL first strategy where a second COL and/or NEO was given in 5/16 (32%) (P = 0.05). Both strategies had similar outcomes (NEO, 4/18 versus COL, 4/16, P = 0.85). Twenty-two (44%) episodes had an early intervention (≤48 h) with NEO and/or COL. There was no difference in outcome between those that received an early intervention and those who did not (5/22 versus 5/28, P = 0.71).
For patients failing conservative measures, a COL first approach was associated with fewer subsequent interventions, but with similar composite outcomes compared to a NEO first approach. Early (≤48 h) intervention with NEO and/or COL was not associated with improved outcomes.
摘要：
背景：新斯的明（NEO）和结肠镜减压术（COL）是两种治疗急性结肠假性梗阻（ACPO）的有效方法。我们假设COL优先策略与NEO优先策略相比具有更好的结果。
方法：2013-2020年进行单中心回顾性分析。包括诊断为ACPO的≥18岁的患者。结果是急性手术干预的综合指标，与ACPO重新接纳30天，和30天ACPO相关死亡率。P值≤0.05表示有统计学意义。
结果：在849名患者的910次遭遇中，在排除一名患者出现结肠穿孔后，在39例患者中发现了50例（5.5％）ACPO发作。中位数（四分位数范围）年龄为68（62-84）y。NEO和COL在21和25发作中被施用，分别。在16（32％）集中，未施用NEO或COL。当患者首先接受NEO治疗时，与COL第一策略相比，在12/18（67％）中需要COL或额外的NEO，其中在5/16（32％）中给予了第二个COL和/或NEO（P=0.05）。两种策略都有相似的结果(NEO，4/18对COL，4/16,P=0.85)。22例（44％）发作有NEO和/或COL的早期干预（≤48h）。接受早期干预的患者和未接受早期干预的患者之间的结果没有差异（5/22对5/28，P=0.71）。
结论：对于保守措施失败的患者，COL第一种方法与较少的后续干预相关，但与NEO第一种方法相比，复合结果相似。早期（≤48小时）的NEO和/或COL干预与改善的结局无关。
方法：2013-2020年进行单中心回顾性分析。包括诊断为ACPO的≥18岁的患者。结果是急性手术干预的综合指标，与ACPO重新接纳30天，和30天ACPO相关死亡率。P值≤0.05表示有统计学意义。
结果：在849名患者的910次遭遇中，在排除一名患者出现结肠穿孔后，在39例患者中发现了50例（5.5％）ACPO发作。中位数（四分位数范围）年龄为68（62-84）y。NEO和COL在21和25发作中被施用，分别。在16（32％）集中，未施用NEO或COL。当患者首先接受NEO治疗时，与COL第一策略相比，在12/18（67％）中需要COL或额外的NEO，其中在5/16（32％）中给予了第二个COL和/或NEO（P=0.05）。两种策略都有相似的结果(NEO，4/18对COL，4/16,P=0.85)。22例（44％）发作有NEO和/或COL的早期干预（≤48h）。接受早期干预的患者和未接受早期干预的患者之间的结果没有差异（5/22对5/28，P=0.71）。
结论：对于保守措施失败的患者，COL第一种方法与较少的后续干预相关，但与NEO第一种方法相比，复合结果相似。早期（≤48小时）的NEO和/或COL干预与改善的结局无关。
