title: Colonoscopy is superior to neostigmine in the treatment of Ogilvie's syndrome.
abstract: BACKGROUND
  Colonic pseudo-obstruction in critically ill patients may lead to devastating colonic perforation. Neostigmine is often the first-line intervention, because colonoscopy is more invasive and labor intensive.
  
  
  METHODS
  A retrospective 10-year review at a tertiary medical center identified 100 patients with Ogilvie's syndrome, in whom treatment course and clinical and radiographic response were evaluated.
  
  
  RESULTS
  Colonoscopy was significantly more successful than neostigmine (defined as no further therapy) after 1 or 2 interventions (75.0% vs 35.5%, P = .0002, and 84.6% vs 55.6%, P = .0031, respectively). One colonoscopy was more effective than 2 neostigmine administrations (75.0% vs 55.6%, P = .044). Clinical response (poor, fair, or good) was significantly better after colonoscopy than neostigmine after 1 or 2 interventions (P = .0028 and P = .00079). Cecal diameters decreased significantly more after colonoscopy than neostigmine (from 10.2 ± .5 cm to 7.1 ± .4 cm vs from 10.5 ± .5 cm to 8.8 ± .5 cm, P = .026). Neostigmine administration before colonoscopy did not affect outcomes. There were 3 perforations (3.7%): 1 each after colonoscopy, neostigmine, and no intervention. Neostigmine dose or repetition did not affect radiographic (P = .41) or clinical (P = .31) response.
  
  
  CONCLUSIONS
  Colonoscopy is superior to neostigmine for Ogilvie's syndrome and should be considered first-line therapy, although neostigmine is useful in select patients and repeat interventions.
authors.affiliation: Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA.
authors.forename: Victor B
authors.initials: VB
authors.lastname: Tsirline
authors.forename: Alla Y
authors.initials: AY
authors.lastname: Zemlyak
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Avery
authors.forename: Paul D
authors.initials: PD
authors.lastname: Colavita
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Christmas
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
mesh_terms: D002432:Cecum / Q000000981:diagnostic imaging / Q000473:pathology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003112:Colonic Pseudo-Obstruction / Q000150:complications / Q000628:therapy*; D003113:Colonoscopy; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009388:Neostigmine / Q000627:therapeutic use*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D009388:Neostigmine