Pyridostigmine Efficacy and Safety for Treatment of Ileus After Colorectal Surgery

NCT ID: NCT05334485

Last Updated: 2026-01-07

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE2/PHASE3
• Total Enrollment: 50 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-09-03
• Study Completion Date: 2026-10-31

Brief Summary

A double blind, placebo controlled, randomized control trial studying the safety and efficacy of pyridostigmine as a rescue therapy for postoperative ileus. Patients who undergo elective colorectal resection with or without creation of an ostomy, and subsequently develop postoperative ileus will be eligible for enrollment. Patients will be randomized to receive either pyridostigmine or placebo in addition to the current elements of standard of care. Patients will also complete the pyridostigmine bromide side effects scale (PBSES) upon enrollment and following each administration of either intervention or placebo to monitor treatment safety and evaluate for the development of side effects.

Conditions

Postoperative Ileus

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

Pyridostigmine

Patients randomized to this group will be given 60mg of pyridostigmine bromide orally, every 12 hours. Pyridostigmine will be administered from the time of diagnosis of postoperative ileus until the return of bowel function, or for a maximum of 48 hours.

Group Type: EXPERIMENTAL

Pyridostigmine Bromide

Intervention Type: DRUG

Oral 60mg pyridostigmine bromide

Placebo

Patients randomized to this group will be given starch orally, every 12 hours for a maximum of 48 hours.

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: OTHER

Oral starch placebo

Interventions

Pyridostigmine Bromide

Oral 60mg pyridostigmine bromide

Intervention Type: DRUG

Placebo

Oral starch placebo

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. Adult (age 18 and over) patients with benign or malignant colonic or rectal disease who have undergone elective laparoscopic, robotic, or open colorectal resections with or without ostomy construction at our center, and subsequently developed POI, defined as symptoms of bloating with or without nausea and vomiting, with absence of passage of flatus or stool for at least 48 hours postoperatively and require return to NPO status after initial diet attempts with or without placement of an NGT.

2. Radiographic confirmation of POI diagnosis either via abdominal radiography (KUB), computed tomography abdomen/pelvis (CT A/P), or both

3. ECOG Performance status < 4

4. Laboratory evidence of normal organ function, defined as:

1. Hemoglobin ≥ 7.0 g/dL

2. WBC ≤ 20,000/mcL and ≥ 4,000/mcL

3. Platelet count ≥ 100,000/mcL or ≤ 100,000,000/mcL

4. AST (SGOT) ≤ 2.5 times the institutional upper limit of normal

5. ALT (SGPT) ≤ 2.5 times the institutional upper limit of normal

6. Total bilirubin within the upper limit of institutional normal range

7. Serum Creatinine within the upper limit of institutional normal range

Exclusion Criteria

1. Radiographic evidence of bowel obstruction

2. Documented intraabdominal septic complications (IASC, such as abdominopelvic abscess, peritonitis, anastomotic leak) at any time prior to or after enrollment

3. Isolated small bowel or ostomy surgery without colon or rectal resection

4. ASA score 5

5. Pregnant or breastfeeding females as PYR is classified by the FDA as a pregnancy risk category C medication with the potential for teratogenic or abortifacient effects and demonstrated secretion into breastmilk with an unknown but potential risk for adverse effects in the nursing infants

6. Current use of any other investigational agents including: neostigmine or other acetylcholine esterase inhibitors, alvimopan, metoclopramide, erythromycin, methylnaltrexone, naloxegol, cisapride, and laxatives or cathartics (i.e. milk of magnesia, polyethylene glycol)

7. History of allergic reactions attributed to PYR or other acetylcholine esterase inhibitors

8. Patients with any of the following uncontrolled, concurrent illnesses: active or latent MG, bronco-constrictive disease (asthma/reactive airway disease), chronic obstructive lung disease (COPD), symptomatic congestive heart failure (CHF), unstable angina pectoris, cardiac arrhythmia including bradycardia, renal failure, hepatic failure, gastroparesis, short bowel syndrome (small bowel < 200cm), preexisting short or large bowel dysmotility or pseudo-obstruction, chronic constipation/laxative use, peritoneal carcinomatosis, and psychiatric illness/social situations that would limit compliance with study requirements

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Stefan Holubar MD MS FACS, FASCRS

OTHER

Sponsor Role: lead

Responsible Party

Stefan Holubar MD MS FACS, FASCRS

Principal Investigator

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Stefan D Holubar

Role: PRINCIPAL_INVESTIGATOR

The Cleveland Clinic

Locations

Cleveland Clinic Main Campus

Cleveland, Ohio, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Stefan D Holubar

Role: CONTACT

holubas@ccf.org

2164447000

Facility Contacts

Stefan D Holubar, MD/MS

Role: primary

holubas@ccf.org

2164447000

Other Identifiers

21-915

Identifier Type: -

Identifier Source: org_study_id