Role of Endoscopy in the Management of Acute Colonic Pseudo-Obstruction and Colonic Volvulus

Publication Date: February 1, 2020
Last Updated: March 14, 2022

RECOMMENDATIONS

For patients with uncomplicated sigmoid volvulus, we suggest endoscopy as the initial treatment modality. After successful detorsion, placement of decompression tube should be considered to maintain reduction and decrease risk of recurrence. (★★)
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For patients with sigmoid volvulus, we suggest surgical consultation during index admission given the high risk of recurrent volvulus and high morbidity and mortality associated with each episode. (★★★)
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For patients with cecal volvulus, we recommend pursuit of surgical management as initial treatment modality and avoidance of endoscopic intervention given the high risk of perforation. (★★★)
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For patients with colon volvulus with overt perforation or signs of peritonitis, we recommend surgical management. (★★★)
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For patients with uncomplicated ACPO (absence of ischemia, peritonitis, cecal diameter <12 cm, and/or significant abdominal pain), we recommend conservative therapy as the preferred initial management including identifying and correcting potentially contributing metabolic, infectious, and pharmacologic factors. (★★★)
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For patients with ACPO who are not candidates for conservative therapy, have failed conservative therapy (up to 72 hours), or are at risk for perforation and have no contraindication to its use, we recommend pharmacologic therapy with neostigmine (2 mg over 3-5 minutes) with appropriate cardiovascular monitoring. (★★★)
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For patients with ACPO who do not respond to a first dose of neostigmine, we suggest the administration of a second dose of neostigmine. (★)
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For patients with ACPO refractory to bolus dosing of neostigmine, we suggest alternative routes of neostigmine administration including subcutaneous or continuous intravenous infusion. (★)
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For patients with ACPO who are not candidates for conservative therapy or have failed conservative therapy (up to 72 hours) and have no contraindication to endoscopy, we suggest colonic decompression with decompression tube placement as an alternative. (★★)
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For patients with ACPO with overt perforation or signs of peritonitis, we recommend surgical management. (★★★)
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Recommendation Grading

Overview

Title

Role of Endoscopy in the Management of Acute Colonic Pseudo-Obstruction and Colonic Volvulus

Authoring Organization

American Society for Gastrointestinal Endoscopy

Publication Month/Year

February 1, 2020

Last Updated Month/Year

August 29, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this document from the American Society for Gastrointestinal Endoscopy’s Standards of Practice Committee is to provide an update on the evaluation and endoscopic management of sigmoid volvulus and ACPO

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D045822 - Intestinal Volvulus, D003112 - Colonic Pseudo-Obstruction, D007415 - Intestinal Obstruction

Keywords

endoscopy, Acute colonic pseudo-obstruction, Colon volvulus, sigmoid volvulus

Source Citation

Naveed M, Jamil LH, Fujii-Lau LL, Al-Haddad M, Buxbaum JL, Fishman DS, Jue TL, Law JK, Lee JK, Qumseya BJ, Sawhney MS, Thosani N, Storm AC, Calderwood AH, Khashab MA, Wani SB. 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. doi:10.1016/j.gie.2019.09.007. Epub 2019 Nov 30. Erratum in: Gastrointest Endosc. 2020 Mar;91(3):721. PMID: 31791596.