Outcome of colonoscopic decompression in acute colonic pseudo-obstruction: A systematic review and meta-analysis.

Background: Acute colonic pseudo-obstruction (ACPO) is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor. Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.

Aim: To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.

Methods: A search was conducted in MEDLINE, EMBASE, and Scopus from inception to August 2024. Studies reporting the clinical success, perforation, recurrence, and need for surgery after colonoscopic decompression in ACPO were included. A random-effects inverse-variance model was used to calculate the pooled proportion.

Results: Sixteen studies were included in the final analysis. The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8% (95%CI: 72.0-85.6) and 91.5% (95%CI: 87.0-96.0), respectively. The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85 (95%CI: 2.00-7.42). The pooled incidence of perforation was 0.9% (95%CI: 0.0-2.0), while recurrence was observed in 17.1% (95%CI: 12.9-21.3) of the patients after clinical success. The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5% (95%CI: 5.0-15.9) and 3.7% (95%CI: 0.3-7.1), respectively. Subgroup analysis, excluding the low-quality studies, did not significantly change the event rates.

Conclusion: Colonoscopic decompression for ACPO is associated with a clinical success rate of > 90% with a perforation rate of < 1%, demonstrating high efficacy and safety.