In chronic intestinal pseudo-obstruction (CIPO), a defined escalation pathway applies when earlier device-based and investigational interventions have been exhausted without achieving the expected clinical response.

Prior therapy — insufficient response

The preceding treatment line comprised device and investigational therapies: gastric and intestinal pacemakers (high-frequency electrical stimulation via implanted electrodes), botulinum toxin injection into the pylorus and anus to improve sphincter transit, and hyperbaric oxygenation in myopathic CIPO presenting with abdominal distension and obstructive symptoms. When these measures fail to deliver meaningful improvement in nausea and vomiting, escalation to the next defined protocol is warranted.

Next-line approach — partial overview

This protocol involves a form of intestinal transplantation. The specific surgical strategy is determined by the patient's gastric motility status — the full protocol details which approach applies under which conditions. No dosage information is applicable to this intervention class; eligibility criteria and indication specifics are defined within the complete regimen.

References

DOI: 10.1053/j.gastro.2005.06.081

Small intestinal transplantation is indicated in TPN-dependent pseudo-obstruction patients with life-threatening complications of TPN or with dwindling venous access.
In the presence of preserved gastric motility, isolated small-bowel transplant is preferred.
However, if stomach motility is impaired severely, multivisceral transplantation is warranted.

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What to Do When Device and Investigational Therapies Have Not Improved Nausea and Vomiting in Chronic Intestinal Pseudo-Obstruction

References