Outcome of colonoscopic decompression in acute colonic pseudo-obstruction: A systematic review and meta-analysis

Table 1 Baseline characteristics of the studies included in the meta-analysis, n (%)

Ref.	Study design, country	No. of patients	Age	Male sex	Etiology	Cecal diameter, in cm	Prior neostigmine	Tube placement
Nivatvongs et al[9]	Retrospective, United States	22	56 (30-82)	15 (68.2)	Post-surgical: 18 (81.8); Critically ill: 4 (18.2)	-	-	0
Strodel et al[10]	Retrospective, United States	44	59 (25-89)	31 (70.4)	Post-surgical: 12 (27); Critically ill: 29 (66)	12.8 (9.5-17)	-	0
Bode et al[11]	Retrospective, United States	22	64.3 (21-92)	15 (68.2)	Post-surgical: 13 (59.1); Critically ill: 9 (40.9)	12.9 (10-17)	-	0
Fausel and Goff[12]	Retrospective, United States	19	46-80	17 (89.4)	Post-surgical: 8 (42.1); Critically ill: 11 (57.9)	13 (12-15)	-	-
Lavignolle et al[13]	Retrospective, France	29	-	-	-	-	-	15 (51.7)
Harig et al[14]	Retrospective, United States	20	60-78	12 (60)	Post-surgical: 8 (40); Critically ill: 12 (60)	-	-	10 (52.6)
Jetmore et al[15]	Retrospective, United States	48	67 (36-90)	33 (68.7)	Post-surgical: 27 (56); Critically ill: 21 (44)	12.4	-	42 (87)
Geller et al[16]	Retrospective, United States	50	68 ± 13	33 (66)	Post-surgical: 33 (66); Critically ill: 17 (34)	13 (9-20)	-	42 (84)
Pham et al[17]	Retrospective, United States	24	65 (34-85)	20 (83)	Post-surgical: 9 (38); Critically ill: 15 (62)	12.6 ± 3.1	-	8 (75)
Tsirline et al[18]	Retrospective, United States	52	-	-	-	-	-	-
Peker et al[19]	Retrospective, Turkey	54	59.4 ± 15.3	-	-	10.8 ± 1.2	16 (30.2)	-
Zhao et al[20]	Prospective, China	59	-	-	-	-	59 (100)	-
Mankaney et al[21]	Retrospective, United States	83	66.8 ± 16.2	60 (72.3)	Post-surgical: 27 (32.5); Critically ill: 13 (54.2)	-	25 (30)	-
Liu et al[22]	Retrospective, United States	24	72.2 (51-93)	19 (79.2)	Post-surgical: 11 (45.8); Critically ill: 13 (54.2)	12.5	-	14 (58.3)
Joechle et al[23]	Retrospective, Germany	25	64 (34-86)	19 (76)	Critically ill: 25 (100)	9 (6-13)	-	19 (76)
Williamson et al[24]	Retrospective, United States	16	68 (62-84)	12 (73)	-	-	-	-

Table 2 Outcome of individual studies included in the analysis, n (%)

Ref.	No. of patients	Initial success	Overall success	Perforation	Recurrence after decompression	Need for surgery overall after successful decompression
Nivatvongs et al[9]	22	19 (86.4)	19 (86.4)	0	4/19 (21.0)	3/22 (13.6) | 2/19 (10.5)
Strodel et al[10]	44	32 (72.7)	34 (77.3)	1 (2.3)	5/34 (14.7)	7/44 (15.9) | 1/34 (2.9)
Bode et al[11]	22	20 (91)	20 (91)	1 (4.5)	4/20 (20)	3/22 (13.6) | 2/20 (10)
Fausel and Goff [12]	19	-	17 (89.5)	0	3/17 (17.6)	3/19 (15.8) | 2/17 (11.8)
Lavignolle et al[13]	29	-	29 (100)	0	7/29 (24.1)	-
Harig et al[14]	20	18 (90)	20 (100)	0	4/20 (20)	-
Jetmore et al[15]	45	29 (64.4)	38 (84.4)	1 (2.2)	6/38 (15.8)	5/45 (11.1)
Geller et al[16]	50	39 (78)	44 (88)	1 (2)	8/44 (18.2)	1/50 (2)
Pham et al[17]	24	22 (91)	23 (95.8)	0	-	-
Tsirline et al[18]	52	39 (75)	44 (85)	1 (1.9)	-	-
Peker et al[19]	54	44 (81.5)	-	-	-	-
Zhao et al[20]	59	27 (45)	-	-	-	-
Mankaney et al[21]	83	73 (87.9)	-	0	11 (15.1)	-
Liu 2021[22]	24	22 (91.6)	23 (95.8)	1 (4.2)	-	1/24 (4.2) | 1/23 (4.3)
Joechle et al[23]	25	17 (68)	-	6 (24)	-	8/25 (32) | 0/17
Williamson et al[24]	16	11 (68.7)	-	0	1/11 (9.1)	1/16 (6.2) | 0/11

Table 3 Summary of findings from the overall and sub-group analysis

Outcomes	Overall	Exclusion of low-quality studies
Initial success	78.8% (95%CI: 72.0-85.6), I2 = 77.0%	83.4% (95%CI: 77.0-89.7), I2 = 57.8%
Overall success	91.5% (95%CI: 87.0-96.0), I2 = 63.4%	91.6% (95%CI: 86.4-96.8), I2 = 65.7%
Perforation	0.9% (95%CI: 0.0-2.0), I2 = 0.0%	0.7% (95%CI: 0.0-1.9), I2 = 0.0%
Recurrence	17.1% (95%CI: 12.9-21.3), I2 = 0.0%	17.6% (95%CI: 13.2-21.9), I2 = 0.0%
Need for surgery	10.5% (95%CI: 5.0-15.9), I2 = 59.9%	8.9% (95%CI: 3.7-14.0), I2 = 50.8%
Need for surgery after success	3.7% (95%CI: 0.3-7.1), I2 = 0.0%	5.2% (95%CI: 1.2-9.3), I2 = 0.0%