The Efficacy and Safety of Methylnaltrexone for the Treatment of Postoperative Ileus.

Abstract

Postoperative ileus (POI) is a surgical complication resulting in increased morbidity and length of stay (LOS). Usual care for POI includes bowel rest and gastric decompression. It has been questioned if methylnaltrexone (MNTX), a peripheral opioid antagonist, could be used as treatment for POI. The purpose of this study was to determine if MNTX is effective and safe for POI treatment. This single-center, retrospective cohort study included patients ⩾ 18years with a POI. Patients with acute colonic pseudo-obstruction, small bowel obstruction, and gastrointestinal malignancy were excluded. The intervention was MNTX administration. The primary outcome was time to ileus resolution. Secondary outcomes included LOS, duration of nasogastric tube, total parenteral nutrition requirement, and incidence of gastrointestinal perforations. 110 patients were included in the analysis; 28 received MNTX. Time to ileus resolution was 9.9days for the MNTX group and 11.4days for the control group (P = .38). Duration of gastric decompression was 4.6days for the MNTX group and 4.2days for the control group (P = .71). Length of stay was 19.9days for the MNTX group and 19.7days for the control group (P = .96). The percentage of TPN requirement was 17.9% in the MNTX group and 22.0% in the control group (P = .65). No gastrointestinal perforations were observed in either group. For the treatment of POI, MNTX did not significantly reduce time to resolution of ileus, LOS, duration of gastric decompression, or TPN requirements. However, no gastrointestinal perforations were seen, indicating that MNTX may be safely used in these patients.