Endoscopic Management of Acute Colonic Obstruction and Pseudo-obstruction

Abstract

In acute colonic pseudo-obstruction (ACPO), supportive management and medical treatment with neostigmine are initial mainstays of therapy. Colonoscopic decompression with tube placement provides reliable relief in patients who do not respond to medical therapy or have contraindications to the use of neostigmine. Advanced techniques, such as percutaneous endoscopic cecostomy or colostomy, are alternatives to tube decompression, although additional studies are needed to assess their safety and efficacy. Self-expanding metal stent placement for acute colonic obstruction (ACO) due to malignancy is indicated in a palliative setting or as a preoperative bridge until definitive surgery is feasible. Decompression tube placement and tumor debulking with endoscopic laser treatment are no longer first-line therapy for malignant ACO. Recent advances in endoscopic management of ACPO and MCO have reduced the need for emergent surgery, with high technical and clinical success rates and improved patient outcomes.