Management of sigmoid volvulus using percutaneous endoscopic colostomy.

Area of Science:

• Gastroenterology
• Surgical Innovation
• Interventional Endoscopy

Background:

• Sigmoid volvulus poses a significant challenge in frail, comorbid patients.
• Traditional surgical interventions may carry high risks for this patient population.
• Endoscopic decompression alone may not be sufficient for recurrent cases.

Purpose of the Study:

• To systematically review the literature on percutaneous endoscopic colostomy (PEC) for sigmoid volvulus.
• To evaluate PEC as an alternative to major surgery or simple endoscopic decompression.
• To assess outcomes in frail, comorbid patients with sigmoid volvulus.

Main Methods:

• Systematic literature search (April 2000 - January 2017) in MEDLINE, Embase, and CINAHL.
• Inclusion criteria focused on studies of PEC for sigmoid volvulus in specific patient groups.
• Screening and exclusion of studies not meeting predefined criteria.

Main Results:

• Seven observational studies and seven case reports (81 patients) were included.
• Recurrent sigmoid volvulus occurred in 10 patients (3 with tubes in situ, 7 after removal).
• Most frequent morbidity was site infection (n=6); seven deaths were reported post-procedure.

Conclusions:

• PEC is a viable alternative for managing recurrent sigmoid volvulus in high-risk patients.
• Indefinite in-situ placement of two PEC tubes demonstrated superior outcomes.
• Further research is warranted to optimize PEC safety, efficacy, and post-procedure care.