Role of Endoscopy in the Management of Acute Colonic Pseudo-Obstruction and Colonic Volvulus
Publication Date: February 1, 2020
Last Updated: March 14, 2022
RECOMMENDATIONS
For patients with uncomplicated sigmoid volvulus, we suggest endoscopy as the initial treatment modality. After successful detorsion, placement of decompression tube should be considered to maintain reduction and decrease risk of recurrence. (★★)
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For patients with sigmoid volvulus, we suggest surgical consultation during index admission given the high risk of recurrent volvulus and high morbidity and mortality associated with each episode. (★★★)
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For patients with cecal volvulus, we recommend pursuit of surgical management as initial treatment modality and avoidance of endoscopic intervention given the high risk of perforation. (★★★)
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For patients with colon volvulus with overt perforation or signs of peritonitis, we recommend surgical management. (★★★)
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For patients with uncomplicated ACPO (absence of ischemia, peritonitis, cecal diameter <12 cm, and/or significant abdominal pain), we recommend conservative therapy as the preferred initial management including identifying and correcting potentially contributing metabolic, infectious, and pharmacologic factors. (★★★)
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For patients with ACPO who are not candidates for conservative therapy, have failed conservative therapy (up to 72 hours), or are at risk for perforation and have no contraindication to its use, we recommend pharmacologic therapy with neostigmine (2 mg over 3-5 minutes) with appropriate cardiovascular monitoring. (★★★)
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For patients with ACPO who do not respond to a first dose of neostigmine, we suggest the administration of a second dose of neostigmine. (★)
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For patients with ACPO refractory to bolus dosing of neostigmine, we suggest alternative routes of neostigmine administration including subcutaneous or continuous intravenous infusion. (★)
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For patients with ACPO who are not candidates for conservative therapy or have failed conservative therapy (up to 72 hours) and have no contraindication to endoscopy, we suggest colonic decompression with decompression tube placement as an alternative. (★★)
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For patients with ACPO with overt perforation or signs of peritonitis, we recommend surgical management. (★★★)
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Title
Role of Endoscopy in the Management of Acute Colonic Pseudo-Obstruction and Colonic Volvulus
Authoring Organization
American Society for Gastrointestinal Endoscopy
Publication Month/Year
February 1, 2020
Last Updated Month/Year
March 16, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
The purpose of this document from the American Society for Gastrointestinal Endoscopy’s Standards of Practice Committee is to provide an update on the evaluation and endoscopic management of sigmoid volvulus and ACPO
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Diseases/Conditions (MeSH)
D045822 - Intestinal Volvulus, D003112 - Colonic Pseudo-Obstruction, D007415 - Intestinal Obstruction
Keywords
endoscopy, Acute colonic pseudo-obstruction, Colon volvulus, sigmoid volvulus
Source Citation
Naveed M, Jamil LH, Fujii-Lau LL, Al-Haddad M, Buxbaum JL, Fishman DS, Jue TL, Law JK, Lee JK, Qumseya BJ, Sawhney MS, Thosani N, Storm AC, Calderwood AH, Khashab MA, Wani SB. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus. Gastrointest Endosc. 2020 Feb;91(2):228-235. doi:10.1016/j.gie.2019.09.007. Epub 2019 Nov 30. Erratum in: Gastrointest Endosc. 2020 Mar;91(3):721. PMID: 31791596.