Two decades of endoscopic detorsion in sigmoid volvulus: prognostic factors for failure

Endoscopic detorsion is the first-line treatment for sigmoid volvulus. However, a significant proportion of patients experience treatment failure, requiring emergency surgery, which is associated with increased morbidity. Identifying predictive factors for detorsion failure is crucial for optimizing management strategies and improving patient outcomes.

This retrospective cohort study analyzed 49 patients who underwent endoscopic detorsion for sigmoid volvulus at two tertiary hospitals in Thailand from 2004 to 2024. Demographic, clinical, and radiologic data were collected. Regression analysis, directed acyclic graphs (DAGs), and receiver operating characteristic (ROC) analysis were used to identify factors associated with detorsion failure.

Of the 49 patients who underwent endoscopic detorsion, 19 (38.8%) experienced treatment failure. Multivariable regression analysis identified BMI ≥ 18.5 kg/m2 as associated with lower odds of detorsion failure (adjusted OR: 0.12, 95% CI 0.02-0.86, p = 0.04). Cecal diameter ≥ 6.8 cm was associated with increased failure risk (adjusted OR: 5.35, 95% CI 1.08-26.58, p = 0.04). Patients in the failed detorsion group had a significantly higher rate of postoperative ostomy creation (61.1% vs. 4.5%, p < 0.001), with 72.7% of these ostomies remaining unclosed.

Our findings suggest that patients with a cecal diameter ≥ 6.8 cm and BMI < 18.5 kg/m² are poor candidates for endoscopic detorsion and should be considered for early surgical intervention.