The article I chose is called Neostigmine for acute colonic pseudo-obstruction: a meta-analysis. It was published in the Annals of Medicine and Surgery in 2014 and written by Raul Guillermo Lopez Valle and Francisco Lopez Godoy. As aforementioned, the article is a meta-analysis that looked at 4 studies including 127 patients with acute colonic pseudo-obstruction to evaluate the effectiveness and side effects of using neostigmine as treatment versus conservative management. Conservative management was considered as gastric decompression, fluid and electrolyte balance correction, rectal tube decompression, limiting offending drugs and the diligent treatment of any underlying condition usually given for 48-72 hours. Of the 127 patients 65 were in the treatment group using neostigmine and 62 were in the control group being treated with conservative management. The meta-analysis found that neostigmine was 89.2 % effective at resolving ACPO with only one dose versus 14.65% with conservative management. Side effects that were reported with neostigmine included abdominal pain (53.1%), sialorrhoea (31.1%), vomiting (15.6%) and bradycardia (6.3%). The optimal dose of neostigmine is still debatable, and time of resolution was not analyzed. It is also important to note the limitations of this meta-analysis, with one being the small sample size. The studies included were also few low-powered RCTs. Another limitation is that it is not known whether certain causes of ACPO are more sensitive to neostigmine. There also were no studies that provided specific information about the distribution of causes of ACPO. At this time, conservative management should continue to be the initial management for ACPO as there is a need for larger scale, controlled studies for neostigmine, but neostigmine can be as effective if conservative management fails. If neostigmine is being used for treatment, patients should be counseled on potential side effects, although overall safe. Monitoring with cardiac telemetry should also be considered as bradycardia was one of the side effects reported.