P5095 - Evolving Treatment of Acute Colonic Pseudo-Obstruction: A Large Single Center Review

Yara Salameh, MD¹, Hadi Khaled. Abou Zeid, MD², Bishnu D.. Pathak, MBBS², Abdelazeem Elbeih, MD², Rana Mohamed, MD², Moataz Aboeldahb, MBBCh³, Nayantara Coelho-Prabhu, MBBS, FACG², David H. Bruining, MD², Andrew Storm, MD²
1Mayo Foundation for Medical Education and Research, Rochester, MN; 2Mayo Clinic, Rochester, MN; 3Mayo Clinic College of Medicine and Science, Rochester, MN

Introduction: Acute colonic pseudo-obstruction (ACPO) is marked by significant colonic distension without mechanical blockage. While often reversible, delayed or inadequate treatment can lead to serious complications such as ischemia or perforation. Although conservative management is the first-line approach, real-world management often involves a combination of interventions. This study evaluates a large institutional experience with ACPO, focusing on treatment strategies, escalation patterns, and outcomes.

Methods: A retrospective review was conducted on 388 patients diagnosed with ACPO. Conservative management was defined per ASGE guidelines as nasogastric decompression, bowel rest, and correction of fluid and electrolyte imbalances. Additional interventions included bowel regimens (laxatives or enemas), neostigmine, endoscopic decompression, and surgery. First-line treatment referred to therapies initiated within 72 hours of diagnosis. Treatment failure was defined as lack of clinical improvement or clinical deterioration after 72 hours, requiring escalation of care.

Results: Of the 388 patients (70.9% male, mean age 66 ± 16.5 years), the most common etiology of ACPO was post-surgical bowel dysmotility (54.7%), followed by medication-induced dysmotility (26.9%) and critical illness (16.5%). At presentation, 95% had abdominal distension or pain, and over half (58.3%) had a colonic dilation affecting 3 or more segments with a mean diameter of 11.4 ± 5.75 cm. Conservative management was the initial strategy for 81 patients (20.8%), while 175 (45%) patients received additional bowel regimens, and 71 (18.3%) received neostigmine (alone or as part of a combination of treatments) as first line. Endoscopic decompression was used in 10.3%, and surgery in 1%. First-line therapy was successful in 62.9% (n=244). Among failures, escalation to neostigmine (n=48), endoscopic decompression (n=60), or both led to a cumulative secondary success rate of 61.1%. Notably, only 6 patients (1.5%) ultimately required surgery, and overall mortality was 1.8% (n=4), all due to disease complications rather than interventions. No treatment-related complications were observed.

Discussion: A high clinical index of suspicion is vital for timely diagnosis of ACPO, especially in hospitalized patients. Sequential, multimodal treatment escalation appears effective in the majority of cases. Further prospective studies are warranted to refine therapeutic algorithms and optimize outcomes.

Disclosures:
Yara Salameh indicated no relevant financial relationships.
Hadi Abou Zeid indicated no relevant financial relationships.
Bishnu Pathak indicated no relevant financial relationships.
Abdelazeem Elbeih indicated no relevant financial relationships.
Rana Mohamed indicated no relevant financial relationships.
Moataz Aboeldahb indicated no relevant financial relationships.
Nayantara Coelho-Prabhu indicated no relevant financial relationships.
David Bruining: Johnson & Johnson – Consultant.
Andrew Storm: Ambu – Consultant. Apollo Endosurgery – Grant/Research Support. Boston Scientific – Consultant. Boston Scientific – Grant/Research Support. Cook – Consultant. Endogenex – Grant/Research Support. Endo-TAGSS – Grant/Research Support. Enterasense – Grant/Research Support. Envision Endoscopy – Grant/Research Support. Intuitive – Consultant. Medtronic – Consultant. MGI Medical – Grant/Research Support. Olympus – Consultant. OnePass – Grant/Research Support. SofTac – Grant/Research Support.

Yara Salameh, MD¹, Hadi Khaled. Abou Zeid, MD², Bishnu D.. Pathak, MBBS², Abdelazeem Elbeih, MD², Rana Mohamed, MD², Moataz Aboeldahb, MBBCh³, Nayantara Coelho-Prabhu, MBBS, FACG², David H. Bruining, MD², Andrew Storm, MD². P5095 - Evolving Treatment of Acute Colonic Pseudo-Obstruction: A Large Single Center Review, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.