Article of interest: Randomized placebo-controlled study of intravenous methylnaltrexone in postoperative ileus.

Viscusi ER, Rathmell JP, Fichera A, et al. Randomized placebo-controlled study of intravenous methylnaltrexone in postoperative ileus. J Drug Assess. 2013 Aug 27; 2(1):127-34.

Results: A total of 65 patients (methylnaltrexone, n = 33; placebo, n = 32) were randomized. Mean time to first bowel movement was accelerated by 20 h (p = 0.038) and time to discharge eligibility was accelerated by 33 h (p = 0.049) with methylnaltrexone vs placebo. Opioid use was similar between groups until postoperative day 4, then fluctuated in the placebo group. Methylnaltrexone was generally well tolerated.

Conclusions: In this study, intravenous methylnaltrexone significantly decreased time to postoperative bowel recovery and eligibility for hospital discharge by ∼1 d, with an adverse event profile similar to placebo. These were two of several exploratory endpoints; not all efficacy endpoints showed a significant difference between methylnaltrexone and placebo. The efficacy results in this trial were not seen in two subsequent large-scale studies.

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Clinical guideline for management of sigmoid volvulus

One discussion this week included revolvulus after colonic decompression.

Reference: Vogel JD, et al. Clinical practice guidelines for colon volvulus and acute colonic pseudo-obstruction. Diseases of the Colon and Rectum. 2016 Jul;59(7):589-600. doi: 10.1097/DCR.0000000000000602

Summary: Volvulus occurs in the sigmoid colon or cecum in >95% of cases, with the remainder involving either the transverse colon or the splenic flexure of the colon. Sigmoid volvulus affects patients who are older, with more comorbid medical and neuropsychological conditions, compared with those with cecal volvulus.

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