Effect of cisapride on distal colonic motility in the early postoperative period following left colonic anastomosis.
OBJECTIVE
This study was designed to investigate the modulatory effect of cisapride on colonic motility in the postoperative period.


METHODS
A prospective, double-blind, randomized, placebo-controlled trial of 14 patients undergoing left colonic anastomosis was carried out. Manometric probes were positioned with transducers on either side of the anastomosis, and colonic activity was recorded continuously for a median of 98 (range, 72-144) hours using an ambulatory system. Quantitative indices of motility were calculated with an automated analysis program.


RESULTS
Isolated waveform activity returned at a median of 1.8 (interquartile range, 1-3) hours and motor complex activity at 24 (interquartile range, 19-30) hours in the placebo group and at similar times in the cisapride group. All motility variables except mean amplitude increased significantly with time in both groups. In the cisapride group the motility index was significantly increased compared with the placebo group (P = 0.03), resulting from an increase in percentage duration of activity (P = 0.002). Activity index, mean amplitude of waveforms, and number of waves greater than 50 cm H2O did not differ between groups. In contrast to placebo, cisapride significantly increased the median number of waves greater than 13 cm H2O and percentage duration of activity distal to the anastomosis compared with proximally. The return of bowel sounds (median, 43, interquartile range, 24-48 hours vs. 67, 29-69 hours; P = 0.2) or first passage of flatus (78, 54-94 hours vs. 94, 81-105 hours; P = 0.1) did not differ between groups.


CONCLUSIONS
Although cisapride may have a differential effect on the colon proximal and distal to an anastomosis and significantly increases some indices of motility in the early postoperative period, these are unlikely to be of any clinical relevance.
Surgical Research Unit, London Hospital Medical School, Whitechapel, United Kingdom.
J P
JP
Roberts
M J
MJ
Benson
J
J
Rogers
J J
JJ
Deeks
D L
DL
Wingate
N S
NS
Williams
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D020117:Cisapride; D003106:Colon / Q000502:physiology / Q000601:surgery*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005769:Gastrointestinal Motility / Q000187:drug effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy* / Q000209:etiology; D008365:Manometry; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D012086:Reoperation; D012702:Serotonin Antagonists / Q000494:pharmacology / Q000627:therapeutic use*
D010880:Piperidines; D012702:Serotonin Antagonists; D020117:Cisapride