Neostigmine for acute colonic pseudo-obstruction: A meta-analysis

IntroductionAcute colonic pseudo-obstruction (ACPO) is an uncommon condition that occasionally develops in hospitalized patients with serious underlying ailments. Its early recognition is essential to reduce life-threatening complications. Few low-powered randomized clinical trials (RCTs) have confirmed the effectiveness of neostigmine for treatment.AimTo analyse the effectiveness and main side effects of neostigmine in the treatment of ACPO.ExperimentalA literature search was performed for all published RCTs, reporting on neostigmine as treatment for ACPO.ResultsFour studies fulfilled the inclusion criteria, evaluating 127 patients: treatment group = 65, control group = 62. Neostigmine effectiveness to resolve ACPO with only one dose was 89.2% versus 14.65% (P < 0.001, NNT = 1 [95% CI 1–2]).ConclusionsNeostigmine is a safe and effective option for patients with ACPO who failed to respond to conservative management.