Clinical Outcomes After Failed Endoscopic Detorsion for Sigmoid Volvulus: A Single-Center Retrospective Cohort Study.
Endoscopic detorsion for sigmoid volvulus is successful in about 48.8% of cases, and those who fail may require alternative management strategies, with a clinical success rate of 88.4% overall.
Where it sits
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This study evaluated clinical outcomes after failed endoscopic detorsion for sigmoid volvulus in 47 patients. Successful detorsion was achieved in 21 of 43 patients (48.8%), with an overall clinical success rate of 88.4% (38/43). The study assessed recurrence rates and other outcomes in patients who underwent decompression after failed detorsion.
Abstract
<h4>Objectives</h4>Endoscopic detorsion is the first-line treatment for sigmoid volvulus (SV); however, detorsion is not always successful. We evaluated clinical outcomes after failed endoscopic detorsion and assessed recurrence in patients who achieved clinical success after decompression.<h4>Methods</h4>This single-center retrospective cohort study included 47 patients with first-episode SV, of whom 43 underwent endoscopic management. Baseline characteristics and short-term outcomes were compared between successful and failed detorsion groups. Among patients with clinical success, the in-hospital course and 1-year cumulative recurrence were compared between the successful detorsion and successful decompression groups. Cumulative recurrence was evaluated using the Kaplan-Meier method.<h4>Results</h4>Successful detorsion was achieved in 21 of 43 patients (48.8%). Among 22 patients with failed detorsion, 17 achieved clinical success after decompression, whereas five had clinical failure, including four who underwent emergency surgery and one who died the following day. The overall clinical success rate was 88.4% (38/43). Failed detorsion was associated with lower room-air oxygen saturation and higher lactate levels. Clinical success was less frequent in the failed detorsion group (77.3% vs. 100%, <i>p</i> = 0.065), and hospital stay was longer (median 13 vs. 7 days, <i>p</i> = 0.071). Among patients with clinical success, time to resumption of oral intake was shorter in the successful detorsion group (median 1.5 vs. 3 days, <i>p</i> = 0.004), whereas the 1-year cumulative recurrence rate was numerically higher but not statistically significant (79.6 vs. 51.3%, log-rank <i>p</i> = 0.087).<h4>Conclusions</h4>After assessing the need for emergency surgery, decompression alone may not always require immediate repeat detorsion in selected patients who improve clinically.<h4>Trial registration</h4>N/A.