title: Colonoscopic decompression should be used before neostigmine in the treatment of Ogilvie's syndrome.
abstract: BACKGROUND
  Performance of urgent colonoscopy for the purposes of diagnosis and treatment of Ogilvie's syndrome remains controversial. However, no trials have directly compared neostigmine with endoscopic therapy. This study aimed to compare the effect of neostigmine and colonoscopic decompression in the treatment of Ogilvie's syndrome.
  
  
  METHODS
  This study was designed as a retrospective, non-randomized clinical study of sequential patients. Patients who were diagnosed as having acute colonic pseudo-obstruction were separated into two groups after conservative treatment. Group 1 comprised patients who underwent colonoscopic decompression, because they had a poor first response to neostigmine treatment. Group 2 constituted patients who had a poor first response to colonoscopic decompression, and neostigmine was added to the treatment regimen. Groups 1 and 2 were compared for the success of disease management.
  
  
  RESULTS
  In groups 1 and 2, the average age of the patients was 63.19 years (±14.71 years) and 59.45 years (±15.31 years) (p = 0.312), respectively. No significant difference was determined between the groups in terms of distribution of sex, hospital stay, etiologies, and initial cecal sizes in imaging (p > 0.05). Response to first intervention was statistically significant (p < 0.01). Also, the total response was determined statistically significant for hospital stay if colonoscopic decompression was performed (p < 0.01). No recurrence was determined during the 1-month follow-up in both groups. Although there was no etiologic factor for neostigmine response according to univariate analysis results, colonoscopic success was decreased due to age, sex, and the presence of a cardiac disease.
  
  
  CONCLUSIONS
  Although the success rate of neostigmine treatment was significantly lower in our homogeneous groups, no significant decrease was determined in terms of hospital stay, intensive care unit stay, and requirement of colostomy compared with colonoscopic decompression. By comparison, colonoscopic decompression, which was performed by experienced endoscopists as a first-line treatment option, was more effective as an initial therapy and was more effective at avoiding a second treatment modality.
authors.affiliation: Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey. pekerkivancderya@gmail.com.
authors.forename: K D
authors.identifier: http://orcid.org/0000-0002-8887-3505
authors.initials: KD
authors.lastname: Peker
authors.affiliation: Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Cikot
authors.affiliation: Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: M A
authors.initials: MA
authors.lastname: Bozkurt
authors.affiliation: Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Ilhan
authors.affiliation: Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Kankaya
authors.affiliation: Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Binboga
authors.affiliation: Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Seyit
authors.affiliation: Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Alis
mesh_terms: D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D003112:Colonic Pseudo-Obstruction / Q000000981:diagnostic imaging / Q000628:therapy*; D003113:Colonoscopy; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D009388:Neostigmine
keywords: Acute colonic pseudo-obstruction; Colonoscopic decompression; Neostigmine; Ogilvie’s syndrome