The effect of the timing of endoscopic detorsion on clinical outcomes in patients with sigmoid volvulus.

Abstract

Background and aims: Guidelines recommend endoscopic detorsion in cases of sigmoid volvulus without ischemia or perforation, but the timing in which this should be performed is unclear.

Methods: Admissions for sigmoid volvulus in which endoscopic detorsion was performed between 1/2010-4/2024 were retrospectively reviewed. The timing was calculated as the time between when the confirmatory radiologic exam and endoscopic detorsion were performed. The timing was compared to various patient outcomes.

Results: 118 episodes of sigmoid volvulus from 73 unique adult patients were included (mean age 69.0; 76.3% male). The median time until endoscopic detorsion was 225.5 minutes (IQR 144.5-478.3) with 81 (68.6%) performed in <6 hours. The timing of detorsion was not associated with the presence of ischemia (p=0.289) or a combination of serious outcomes (p=0.777). Those who underwent delayed endoscopic detorsion (>6 hours) were more likely to be younger (62.4 vs 67.4, p=0.034) and have had a rectal tube placed (59.5% vs 21.0%, p<0.001). Delayed cases were associated with a longer length of admission (5.0 vs 3.0 days, p=0.011); however, other outcomes such as the success of endoscopic detorsion, presence of ischemia, readmission rate, and mortality rate showed no difference between the groups. In a multivariate regression analysis, serious outcomes were associated with "on call" status (p=0.045), but not the timing of detorsion (p=0.404).

Conclusions: There does not appear to be a clear correlation between a longer delay until endoscopic detorsion and worse patient outcomes, with only the length of hospitalization affected. This suggests that endoscopic detorsion need not always be performed urgently.