Mo1228 Deflating the Pipes: A New Way of Colonic Decompression

Abstract

Introduction The standard endoscopic treatment of a symptomatic colonic pseudo-obstruction is by placing a 14Fr, 175cm long colonic decompression tube. We wanted to assess the effect of large bore orogastric Ewald stomach evacuator tubes (32Fr) placed rectally for decompression due to its large size, easy accessibility, and obviating the need for proximal colonic intubation. Methods This is a retrospective case series assessing the effectiveness, safety and outcomes of rectally placed orogastric tubes used for decompression of colonic pseudo-obstruction, ileus and volvulus from 2013 to 2014 at a single institution. Clinical outcomes were measured by symptom resolution with >50% reduction of distention on imaging. Results Twenty one patients with colonic pseudo-obstruction, ileus and volvulus were evaluated. The average age was 68.7 ± 12.2 (SD) years of which 13 (59%) were men. Eleven patients had medical etiologies causing distention while 6 patients were postoperative. Seventeen patients (81%) had associated comorbidities including cardiovascular (80%), pulmonary (28%), sepsis (14%), and were ventilator dependent (19%). Twelve patients (57%) failed medical therapy including neostigmine, erythromycin and metoclopramide. Eighteen (85.71%) patients were taking medication including narcotics, benzodiazepines and calcium channel blockers, either alone or in combination. The mean distention diameter was 9.2 ± 3 (SD) cm. Fifteen (71%) patients had improvement after the first procedure while 2 (9.5%) patients had improvement after more than one procedure. Three (17.6%) had a recurrence while 4 (19%) patients had no improvement. Overall success rate was 80.9%. The average time for improvement was 1.58 days with no procedure related complications. Conclusion Large bore gastric tubes placed rectally provide an alternative to the conventional colonic decompression tubes with good initial successful decompression without any complications.