Clinical Factors Associated With Endoscopic Decompression Failure and Recurrent Sigmoid Volvulus: A Retrospective Cohort Study

Abstract

Introduction: Although sigmoid volvulus is a potentially life-threatening condition in elderly patients, its prognostic factors are not well-known. This study aimed to evaluate clinical outcomes and identify prognostic factors in patients with sigmoid volvulus. Methods: This retrospective cohort study included 96 patients diagnosed with sigmoid volvulus by abdominal CT between January 2005 and January 2023 at two tertiary referral centers. After patients who underwent emergent surgery, refused endoscopic treatment, or experienced spontaneous decompression were excluded, 75 patients were analyzed. Logistic regression identified factors linked to endoscopic decompression failure, while Cox regression analyzed recurrence factors. Results: Among the 75 patients who underwent endoscopic decompression, 60 (80%) showed improvement, whereas 15 (20%) did not. In the logistic regression analysis, younger (<= 65 years) age (odds ratio [OR], 10.21; 95% confidence interval [CI], 2.21-47.09) and larger (>= 85 mm) maximum cross-sectional diameter of distended colon (OR, 5.06; 95% CI, 1.12-22.87) were associated with failure of initial endoscopic treatment. Among the 60 patients who initially improved with endoscopic treatment, cumulative recurrence rates were 30% at 1 year and 36.7% at 3 years. In the Cox regression analysis, a larger (>= 85 mm) maximum cross-sectional diameter of distended colon (hazard ratio [HR], 3.27; 95% CI, 1.25-8.59) and a greater (>= 230 mm) longitudinal axis length of spiraled colon (HR, 5.18; 95% CI, 1.67-16.05) at diagnosis were related to volvulus recurrence. Conclusions: Younger age (<= 65 years) and severe colonic dilatation (>= 85 mm) were associated with endoscopic decompression failure, while severe colonic dilatation (>= 85 mm) and marked longitudinal elongation (>= 230 mm) were independently related to recurrence. These findings may guide early surgical consultation for high-risk sigmoid volvulus patients and subsequent resection planning after successful decompression.