Benefit of aggressive colonoscopic decompression in the management of colonic pseudo-obstruction

Acute colonic pseudo-obstruction (ACP) can be managed by conservative medical therapy (MT) or by colonoscopic decompression (CD). This study compares the clinical outcome and cost of these therapeutic modalities. Methods: We retrospectively reviewed 100 consecutive colonoscopic decompressions in 74 patients with ACP compared to a cohort group of 15 patients managed without colonoscopy. Both groups were similar with respect to age and underlying medical condition. Return to diet, time to discharge, complications, and treatment costs were reviewed. All data were analyzed utilizing unpaired t-tests. Results: Colonoscopic decompression in the CD group required 1 to 4 attempts (mean 1.3). One MT patient required colonoscopy. Maximal colon diameter was measured on plain x-rays and averaged 12.2 cm. in the CD group compared to 12.4 cm. in the MT group. Advancement to clear liquids and then regular diet averaged 4 and 5 days respectively for the CD group, compared to 8 and 11 days respectively for the MT group (p < 0.025, < 0.031). The CD group averaged 9 days to discharge following decompression while the MT group averaged 16 days (p<0.001). The mean cost of hospitalization was $9,322 versus $16,330 respectively (p < 0.03). Six (8.1%) required surgery in the CD group and one (6.7%) in the MT group. The CD group also incurred 4 cases of pancreatitis (5.4%) and 4 deaths (5.4%). Summary: Colonoscopic decompression for acute colonic pseudo-obstruction is an effective therapeutic modality that provides a more rapid return to diet and discharge. The risk of colostomy is similar with both treatment modalities. Management by CD provides a safe and cost efficient method to treat patients over MT.