Percutaneous endoscopic sigmoidopexy for recurrent sigmoid volvulus in high-risk adults: a systematic review

Recurrent sigmoid volvulus in frail, comorbid adults recurs frequently after detorsion and carries significant risks with resectional surgery. Percutaneous endoscopic sigmoidopexy (PES), defined as fixation of the sigmoid colon to the abdominal wall without an indwelling tube, has been proposed as a tube-free, minimally invasive alternative.

To synthesise outcomes of strict PES (fixation-only; no tube) for recurrent sigmoid volvulus in adults at high surgical risk.

PRISMA-guided review (2000-31 July 2025) registered prospectively with PROSPERO CRD420251111664. MEDLINE, Embase, PubMed, and Cochrane were searched. Inclusion: adults with recurrent sigmoid volvulus managed by PES using T-fasteners, anchor devices, sutures, or clips without a tube. Exclusion: tube-based percutaneous endoscopic colostomy (PEC), open/laparoscopic pexy, colectomy, paediatric/pregnancy cases, non-volvulus pathology. Dual screening/extraction; JBI case report/series appraisal; narrative certainty assessment. Primary outcomes: technical success, recurrence, procedure-related mortality, all-cause mortality. Proportions are reported with Wilson 95% confidence intervals.

Nine reports (2001-2025) including 25 patients met strict PES criteria. Patients were elderly and generally ASA III-IV where stated. Technical success was 100%. Recurrent volvulus occurred in 1/25 (4%); procedure-related mortality was 1/25 (4%); all-cause mortality during follow-up was 7/25 (28%). Complications were mostly minor (pneumoperitoneum, subcutaneous/surgical emphysema, superficial infection); one small-bowel obstruction (internal herniation) resolved by releasing sutures. Follow-up was heterogeneous (median 7.5 months; range 1-44). Evidence certainty is very low.

In carefully selected high-risk adults with recurrent sigmoid volvulus, strict PES appears feasible with high technical success, low recurrence, and low procedure-related mortality while avoiding an indwelling tube. Prospective, standardised, multicentre research with ≥12-month follow-up is warranted.