What are the guideline sources, guidelines and references for Acute colonic pseudo-obstruction ?
Guideline sources The following summarized guidelines for the evaluation and management of acute colonic pseudo- obstruction (ACPO) are prepared by our editorial team based on guidelines from the American Society for Gastrointestinal Endoscopy (ASGE 2020), the European Society of Gastrointestinal Endoscopy (ESGE 2020), and the American Society of Colon and Rectal Surgeons (ASCRS 2016). 1 2 3 Guidelines 1. Diagnostic investigations Initial assessment: Elicit a focused history, perform physical examination, and obtain the following tests in the initial evaluation of patients with suspected colonic volvulus: CBC serum electrolytes renal function tests diagnostic imaging. B 2. Medical management Conservative management: https://web.pathway.md/diseases/rect8YLQsr95UKtcB 1/3 6/23/23, 1:43 AM Acute colonic pseudo-obstruction Pathway Co se at e a age e t: As per ASGE 2020 guidelines, initiate conservative therapy as the preferred initial management, including identifying and correcting potentially contributing metabolic, infectious, and pharmacologic factors, in patients with uncomplicated ACPO (absence of ischemia, peritonitis, cecal diameter < 12 cm, and/or significant abdominal pain). E As per ASCRS 2016 guidelines, initiate supportive treatment in patients with ACPO and focus on the elimination or correction of conditions that predispose to ACPO or prolong its course. B Neostigmine: As per ASGE 2020 guidelines, initiate pharmacologic therapy with neostigmine (2 mg over 3-5 minutes) with appropriate cardiovascular monitoring in patients with ACPO not being candidates for conservative therapy, failed conservative therapy (up to 72 hours), or at risk for perforation and having no contraindication to its use. E Show 2 more As per ASCRS 2016 guidelines, initiate pharmacologic therapy with neostigmine in patients with ACPO not responding to supportive therapy. B 3. Therapeutic procedures Endoscopic decompression: As per ASGE 2020 guidelines, consider performing colonic decompression with decompression tube placement as an alternative in patients with ACPO not being candidates for conservative therapy or failed conservative therapy (up to 72 hours) and having no contraindication to endoscopy. E As per ESGE 2020 guidelines, consider performing endoscopic decompression of the colon in patients with ACPO not improving with conservative treatment. B Show 5 more As per ASCRS 2016 guidelines, consider performing endoscopic decompression of the colon in patients with ACPO if neostigmine therapy is contraindicated or ineffective. B Percutaneous colostomy creation: consider performing percutaneous endoscopic colostomy/cecostomy creation in patients with ACPO refractory to pharmacologic and endoscopic treatment, especially in patients not amenable to surgical intervention because of increased perioperative risk. B 4. Surgical interventions Indications for surgery: As per ASGE 2020 guidelines, perform surgery in patients with ACPO with overt perforation or signs of peritonitis. E As per ASCRS 2016 guidelines, perform surgery in patients with ACPO complicated by colon ischemia or perforation or ACPO refractory to pharmacologic and endoscopic therapies. B https://web.pathway.md/diseases/rect8YLQsr95UKtcB 2/3 6/23/23, 1:43 AM Acute colonic pseudo-obstruction Pathway References 1. Mariam Naveed, Laith H Jamil, Larissa L Fujii-Lau et al. 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. Open 2. Vogel JD, Feingold DL, Stewart DB et al. Clinical Practice Guidelines for Colon Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum. 2016 Jul;59 7 589 600. Open 3. Bas L A M Weusten, Maximilien Barret, Albert J Bredenoord et al. Endoscopic management of gastrointestinal motility disorders - part 2 European Society of Gastrointestinal Endoscopy ESGE Guideline. Endoscopy. 2020 Jul;52 7 600 614. Open https://web.pathway.md/diseases/rect8YLQsr95UKtcB 3/3