Key result
Acetylcholinesterase inhibitors have limited evidence for reducing the incidence of postoperative ileus, despite their known effectiveness in treating acute colonic pseudo-obstruction.
Why the study?
Postoperative ileus is a common complication after colorectal surgery, but there is limited evidence for using acetylcholinesterase inhibitors to reduce its incidence.
Do acetylcholinesterase inhibitors improve gut motility and prevent or treat postoperative ileus in patients following abdominal surgery?
Do acetylcholinesterase inhibitors improve gut motility and prevent or treat postoperative ileus in patients following abdominal surgery?
Acetylcholinesterase inhibitors like neostigmine and pyridostigmine have potential utility in preventing or treating postoperative ileus, though evidence remains limited.
Does not support routine use after abdominal surgery; leaves open efficacy in prospective RCTs.
Postoperative ileus is a common complication in the days following colorectal surgery occurring in up to 50% of patients. When prolonged, this complication results in significant morbidity and mortality, doubling the total costs of hospital stay. Postoperative ileus (POI) results from the prolonged inflammatory phase that is mediated in part by the cholinergic anti-inflammatory pathway. Acetylcholinesterase inhibitors, such as neostigmine and pyridostigmine, delay the degradation of acetylcholine at the synaptic cleft. This increase in acetylcholine has been shown to increase gut motility. They have been effective in the treatment of acute colonic pseudo-obstruction, but there is limited evidence for the use of these medications for reducing the incidence of POI. This review was conducted to summarise the evidence of acetylcholinesterase inhibitors' effect on gut motility and discuss their potential use as part of an enhanced recovery protocols to prevent or treat POI.
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Traeger et al. (2021) conducted a review in Postoperative ileus following abdominal surgery. Acetylcholinesterase inhibitors (neostigmine and pyridostigmine) was evaluated. Acetylcholinesterase inhibitors have limited evidence for reducing the incidence of postoperative ileus, despite their known effectiveness in treating acute colonic pseudo-obstruction.
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