What to do for chronic intestinal pseudo-obstruction when prokinetic medical therapy fails
Clinical scenario
This protocol covers patients with chronic intestinal pseudo-obstruction (CIPO) who have received prokinetic medical therapy but have not reached the required motility and feeding targets, and for whom a next-line intervention is now indicated.
Previous line — failure condition
Prior therapy: Prokinetic medical therapy.
Goals not achieved: Increased antroduodenal motility index and improved tolerance of enteral feeds. Failure to reach these targets is the trigger for escalation to this protocol.
Next-line approach (partial overview)
After prokinetic therapy has not achieved adequate gut motility, a surgical decompression strategy targeting intraluminal transit may be considered. The specific type of intervention — whether an intestinal access procedure or selective resection of a dysmotile segment — depends on clinical criteria detailed in the full protocol.
The complete regimen, including procedural selection criteria and sequencing, is available via the link below.
Treatment goals
Reduced abdominal distension, reduced vomiting, and improved tolerance of enteral feedings. Successful intervention may also reduce dependence on parenteral nutrition and lower the frequency of hospital admissions for obstructive episodes.
References
DOI: 10.1053/j.gastro.2005.06.081
- Gastrostomy, jejunostomy, or loop enterostomy may be required to shorten the gut and facilitate transit of intraluminal contents.
- Resection of localized segments of impaired motility may improve symptoms and decrease the need for parenteral nutrition.
- Such interventions reduce distension, reduce vomiting, and improve quality of life in patients with CIPO on total parenteral nutrition (TPN).
- The ability to tolerate enteral feedings may improve, and the frequency of hospital admissions for obstructive symptoms is reduced.
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