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

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.