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

Ann Med Surg (Lond). 2014 Jun 19;3(3):60-4. doi: 10.1016/j.amsu.2014.04.002. eCollection 2014 Sep.


Introduction: Acute 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.

Aim: To analyse the effectiveness and main side effects of neostigmine in the treatment of ACPO.

Experimental: A literature search was performed for all published RCTs, reporting on neostigmine as treatment for ACPO.

Results: Four 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]).

Conclusions: Neostigmine is a safe and effective option for patients with ACPO who failed to respond to conservative management.

Keywords: Acute colonic pseudo-obstruction; Neostigmine; Side effects.

Publication types

  • Review