Safety and Efficacy of Endoscopic Derotation in Colonic Volvulus Occlusion: Systematic Review and Meta-Analysis

Background: Sigmoid volvulus is a time-critical cause of large-bowel obstruction. While endoscopic detorsion (ED) is the primary intervention for rapid decompression and the assessment of mucosal viability, reported success, recurrence, and mortality rates vary significantly across the literature, complicating evidence-based clinical decision-making. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines (protocol submitted to PROSPERO). MEDLINE/PubMed and Embase were searched from inception to 20 October 2025, supplemented by manual reference screening. We included original prospective or retrospective studies (n ≥ 5) reporting outcomes after ED for sigmoid volvulus, specifically technical success, post-ED recurrence, or mortality. Pooled proportions were estimated using a DerSimonian-Laird random-effects model on the logit scale, with heterogeneity quantified using I² statistics. Administrative database studies were summarized descriptively and excluded from the quantitative synthesis to minimize selection bias. Results: Nineteen studies (2004-2025) met the inclusion criteria from an initial 890 records. Fifteen studies (n = 1738) contributed to the analysis of technical success, yielding a pooled estimate of 80.0% (95% CI: 75.0-83.0%; I² = 87.5%). Seventeen studies (n = 3285) reported recurrence following initially successful ED, with a pooled rate of 33.9% (95% CI: 19.5-52.1%; I² = 97.5%). Sixteen studies (n = 2790) reported mortality; the pooled estimate was 22.6% (95% CI: 18.7-26.4%; I² = 99.6%). This extreme heterogeneity likely reflects variations in patient comorbidities (case-mix) and differing outcome reporting windows rather than procedural risk in isolation. Conclusions: ED is an effective first-line stabilizing intervention for uncomplicated sigmoid volvulus; however, recurrence rates remain high, and outcome estimates exhibit significant heterogeneity. ED should be integrated within a structured clinical pathway that prioritizes standardized mucosal assessment, post-procedural decompression, and the timely planning of definitive management when feasible.