Subcutaneous Neostigmine is Effective and Safe in the Treatment of In-Hospital Colonic Ileus

Author(s): Maneera Chopra, MD, Jason Wagner, MD, Yllen Hernandez-Blanco, MD, Joseph Young, BSc, Colin Goodman, BSc, Nirav Thosani, MD, Asmeen Bhatt, MD PhD

The objective of this study is to compare the efficacy and safety of subcutaneous (SQ) neostigmine to intravenous (IV) neostigmine for the treatment of in-hospital colonic ileus on outcomes such as resolution of ileus, time to stooling, and total adverse events. This is a retrospective, cohort review study of inpatients diagnosed with colonic ileus and treated with either IV or SQ neostigmine. We found that no differences in ileus resolution post-neostigmine comparing the IV (37%; n=11) to the SQ (78%, n=7) (p=0.05) groups, time to first stooling in IV vs SQ (19.5 ± 32.4 hours vs. 5.3 ± 6.4 hours, p= 0.07), need for decompressive colonoscopy (30% vs 22%, p=1.0), and need for ICU admission (28% vs 6%, p= 0.07%) in the IV vs SQ groups respectively, or adverse events (p=0.11) in the IV versus SQ neostigmine groups; although the total neostigmine dose used in the SQ group was lower (p<0.001). There was no statistically significant difference in adverse events in the IV group vs the SQ group (14% vs 11%, p=0.11). Based on these results, SQ neostigmine appears to be effective and safe in resolving colonic ileus.