Promotility agents for the treatment of ileus in adult surgical patients: A practice management guideline from the Eastern Association for the Surgery of Trauma

Abstract

BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17% to 80%. The main mechanisms of the postoperative ileus pathophysiology are fluid overload, exogenous opioids, neurohormonal dysfunction, gastrointestinal stretch, and inflammation. Management includes addressing the underlying cause and supportive care. Multiple medical interventions have been proposed, but effectiveness is uncertain. A working group of the Eastern Association for the Surgery of Trauma aimed to evaluate the effectiveness of metoclopramide, erythromycin, and early enteral nutrition (EEN) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice. METHODS Literature search identified 45 articles appropriate for inclusion. The Grading of Recommendations Assessment, Development and Evaluation methodology was applied to evaluate the effect of metoclopramide, erythromycin, and EEN on the resolution of ileus in adult surgical patients based on selected outcomes: return of normal bowel function, attainment of enteral feeding goal, and hospital length of stay. The recommendations were made based on the results of a systematic review, a meta-analysis, and evaluation of levels of evidence. RESULTS The level of evidence for all PICOs was assessed as low. Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus. Analyses of 32 randomized controlled trials showed that EEN facilitates return of normal bowel function, achieving enteral nutrition goals, and reducing hospital length of stay. CONCLUSION In patients who have undergone abdominal surgery, we strongly recommend EEN to expedite resolution of Ileus, but we cannot recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients. LEVEL OF EVIDENCE Type of Study Therapeutic, level II.

Back Propagation Neural Network-Based Magnetic Resonance Imaging Image Features in Treating Intestinal Obstruction in Digestive Tract Diseases with Chengqi Decoction

“…Smooth tends to bend closer together. There are many methods for MRI image segmentations, including manual, semiautomatic, and fully automatic segmentation [ 19 , 20 ]. Among them, manual segmentation is to directly outline the boundary with a pen on the image, and the segmentation result is completely determined by the practical experience of the segmenter, so the reliability is low.…”

Prokinetics‐safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review

“…A recently published practical guidelines evaluated usefulness of pro-motility agents for treatment of ileus in adult surgical patients. 76 Regarding erythromycin, four RCTs and one prospective study were included, [77][78][79][80][81] for a total of 128 patients treated with erythromycin and 140 patients in the control groups. Erythromycin had no effect on the resolution of ileus.…”

Effect of abdominal hot pack application on gastrointestinal motility recovery after comprehensive gynecologic staging surgery

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