Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Sep 9, 2025; 14(3): 102733
Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.102733
Outcome of colonoscopic decompression in acute colonic pseudo-obstruction: A systematic review and meta-analysis
Suprabhat Giri, Veeraraghavan Krishnamurthy, Devank Shah, Abel Joseph, Sravan Kumar Korrapati, Sudhir Maharshi, Sridhar Sundaram
Suprabhat Giri, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India
Veeraraghavan Krishnamurthy, Department of Gastroenterology, NMC Specialty hospital, Al Ain 6222, Abu Dhabi, United Arab Emirates
Devank Shah, Sudhir Maharshi, Department of Gastroenterology, SMS Medical College and Hospital, Jaipur 302004, Rajasthan, India
Abel Joseph, Division of Gastroenterology and Hepatology, Stanford University, Cleveland, OH 94305, United States
Sravan Kumar Korrapati, Department of Gastroenterology, Pinnacle Hospital, Visakhapatnam 530040, Andhra Pradesh, India
Sridhar Sundaram, Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai 400012, Mahārāshtra, India
Author contributions: Giri S and Sundaram S contributed to the conception and design of the manuscript; Giri S and Maharshi S drafted the initial manuscript; Giri S and Maharshi S contributed to the critical revision of the initial manuscript. All authors contributed to the literature review, analysis, data collection, and interpretation. All the authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2021 Checklist, and the manuscript was prepared and revised according to the PRISMA 2021 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sudhir Maharshi, MD, Professor, Department of Gastroenterology, SMS Medical College and Hospital, Adarsh Nagar, Jaipur 302004, Rajasthan, India. sudhir.maharshi@gmail.com
Received: October 28, 2024
Revised: March 10, 2025
Accepted: March 21, 2025
Published online: September 9, 2025
Processing time: 264 Days and 9.7 Hours
Abstract
BACKGROUND

Acute colonic pseudo-obstruction (ACPO) is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor. Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.

AIM

To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.

METHODS

A search was conducted in MEDLINE, EMBASE, and Scopus from inception to August 2024. Studies reporting the clinical success, perforation, recurrence, and need for surgery after colonoscopic decompression in ACPO were included. A random-effects inverse-variance model was used to calculate the pooled proportion.

RESULTS

Sixteen studies were included in the final analysis. The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8% (95%CI: 72.0-85.6) and 91.5% (95%CI: 87.0-96.0), respectively. The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85 (95%CI: 2.00-7.42). The pooled incidence of perforation was 0.9% (95%CI: 0.0-2.0), while recurrence was observed in 17.1% (95%CI: 12.9-21.3) of the patients after clinical success. The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5% (95%CI: 5.0-15.9) and 3.7% (95%CI: 0.3-7.1), respectively. Subgroup analysis, excluding the low-quality studies, did not significantly change the event rates.

CONCLUSION

Colonoscopic decompression for ACPO is associated with a clinical success rate of > 90% with a perforation rate of < 1%, demonstrating high efficacy and safety.

Keywords: Acute colonic pseudo-obstruction; Ogilvie's syndrome; Colonoscopy; Colonoscopic decompression; Neostigmine

Core Tip: Colonoscopic decompression for acute colonic pseudo-obstruction (ACPO) was associated with a pooled success rate of 78.8% after the first session and an overall success rate of 91.5%. The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85. The pooled incidence of perforation remained less than 1%, while one-sixth of the patients had a recurrence after clinical success. Surgery was required in 3.7% of those who had a successful procedure and 10.5% of all cases receiving colonoscopic decompression. In patients undergoing colonoscopic decompression, tube placement should be attempted with the position of the tube at least until the transverse colon to improve clinical success and reduce recurrence. However, the predictors of failure of colonoscopic decompression in ACPO need to be studied further.