{"id":7021,"date":"2020-01-04T11:22:48","date_gmt":"2020-01-04T10:22:48","guid":{"rendered":"https:\/\/www.endoscopy-campus.com\/?post_type=ec-news&#038;p=7021"},"modified":"2020-01-04T11:22:49","modified_gmt":"2020-01-04T10:22:49","slug":"new-asge-guideline-on-endoscopy-and-management-of-acpo-and-colonic-volvulus","status":"publish","type":"ec-news","link":"https:\/\/www.endoscopy-campus.com\/en\/ec-news\/new-asge-guideline-on-endoscopy-and-management-of-acpo-and-colonic-volvulus\/","title":{"rendered":"New ASGE Guideline on Endoscopy and Management of ACPO and Colonic Volvulus"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><em><strong>Douglas K. Rex, MD, FASGE reviewing Naveed M, et al. Gastrointest Endosc 2019 Nov 29.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Some of the key and\/or interesting findings in the new American Society for Gastrointestinal Endoscopy guideline on management of volvulus and acute colonic pseudo-obstruction (ACPO) are:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Endoscopy with a decompression tube, if possible, is still a first-line treatment for uncomplicated sigmoid volvulus, but surgical consultation should be obtained in the index admission because of high recurrence rates.&nbsp;<\/li><li>Cecal volvulus should be managed surgically from the outset, as there is a high risk of perforation with endoscopy.<\/li><li>In uncomplicated ACPO, conservative therapy (eg, withdrawing offending drugs, correcting underlying risk factors) is appropriate for 48 to 72 hours, with administration of neostigmine to those without a contraindication (2 mg over 3-5 minutes) in a monitored setting and a second dose if the first dose fails.<\/li><li>Several studies suggest that continuous infusion of neostigmine by subcutaneous or intravenous routes may be superior to the usual bolus methods.<\/li><li>Patients who failed neostigmine therapy should undergo colonoscopic decompression by an expert endoscopist, using nonopioid sedation, carbon dioxide, and decompression tube placement.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<figure class=\"wp-block-pullquote\" style=\"border-color:#bd6fb7\"><blockquote><p> COMMENT<br>This is an informative and useful set of recommendations, though the paper suggests that uncomplicated ACPO includes a cecal diameter &lt;12 cm, while much of the literature actually suggests that a diameter \u226512 cm defines ACPO, and that many patients with larger diameters can be successfully treated by nonsurgical approaches, including the usual sequence of pharmacologic therapy and colonoscopic decompression.<\/p><\/blockquote><\/figure>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made. <\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignwide\" style=\"grid-template-columns:27% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"188\" src=\"https:\/\/www.endoscopy-campus.com\/wp-content\/uploads\/d-rex.jpg\" alt=\"\" class=\"wp-image-5921\"\/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"has-large-font-size wp-block-paragraph\">Douglas K. Rex, MD, FASGE <\/p>\n<\/div><\/div>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">CITATION(S) <\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Naveed M, Jamil LH, Fujii-Lau LL, et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus.<em>\u00a0Gastrointest Endosc<\/em>\u00a02019 Nov 29. (Epub ahead of print) (<a rel=\"noreferrer noopener\" href=\"https:\/\/doi.org\/10.1016\/j.gie.2019.09.007\" target=\"_blank\">https:\/\/doi.org\/10.1016\/j.gie.2019.09.007<\/a>) <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Douglas K. Rex, MD, FASGE reviewing Naveed M, et al. Gastrointest Endosc 2019 Nov 29. Some of the key and\/or interesting findings in the new American Society for Gastrointestinal Endoscopy guideline on management of volvulus and acute colonic pseudo-obstruction (ACPO) are: Endoscopy with a decompression tube, if possible, is still a first-line treatment for uncomplicated &#8230; <a title=\"New ASGE Guideline on Endoscopy and Management of ACPO and Colonic Volvulus\" class=\"read-more\" href=\"https:\/\/www.endoscopy-campus.com\/en\/ec-news\/new-asge-guideline-on-endoscopy-and-management-of-acpo-and-colonic-volvulus\/\" aria-label=\"Read more about New ASGE Guideline on Endoscopy and Management of ACPO and Colonic Volvulus\">Read more<\/a><\/p>\n","protected":false},"template":"","categories":[1768,1769],"tags":[1846,1847],"class_list":["post-7021","ec-news","type-ec-news","status-publish","hentry","category-asge-journal-scan","category-asge-kolon","tag-acpo","tag-colonic-volvulus"],"_links":{"self":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news\/7021","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news"}],"about":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/types\/ec-news"}],"wp:attachment":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/media?parent=7021"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/categories?post=7021"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/tags?post=7021"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}