S195 Is There a "Golden Window" for Endoscopic Reduction of Acute Sigmoid Volvulus: A Multicenter Retrospective Study

Abstract

Introduction: Colonic volvulus accounts for around 2% of all bowel obstructions in the United States. the involvement of the sigmoid colon consists of the overwhelming majority of colonic volvulus cases, possibly 60.9–80%. [1]. Per the American Society of Gastrointestinal endoscopy guidelines (ASGE), Non-operative detorsion with flexible sigmoidoscopy is considered first-line therapy in the management of sigmoid volvulus in patients without signs of peritonitis, perforation, or with recurrent or unsuccessful nonoperative decompression [2][3][4]. Despite this recommendation, the ideal timing for endoscopic intervention remains unclear. Methods: We conducted a retrospective study in adult patients admitted for acute sigmoid volvulus in 4 academic centers from January/2010-January/2020. 47 Patients were identified using ICD-9 and ICD-10 codes. Inclusion criteria included adult patients who were initially managed with endoscopic detorsion. The time interval between diagnosis and endoscopic intervention was collected. Primary outcomes included the need for subsequent urgent surgical intervention within 30 days of the endoscopic intervention. Secondary outcomes were hospital length of stay and mortality. Results: A total of 47 patients met the inclusion criteria. 33 patients were males (70.2%). The mean age of the sample was 71.0 (±16.5) years. Successful non-surgical reduction was achieved in 43 patients (91.5%). Endoscopic intervention was aborted in 4 patients for concerns of bowel ischemia or nonviable mucosa. 31 (66%) patients required urgent surgical intervention within 30 days of the endoscopic reduction, with an average interval period of 7 (±8.5) days. Surgical interventions included Hartmann’s procedure, sigmoid colectomy with primary colorectal anastomosis, and total abdominal colectomy. Early endoscopic reduction resulted in fewer subsequent urgent and emergent surgical interventions (p-value = 0.013). Using the ROC curve, a cut-off point of 8.5 hours was determined to be predic table of favorable outcomes with a sensitivity and specificity of 74.2%, and 75%, respectively. (Figure) Early endoscopic intervention was associated with shorter hospitalization (p-value = 0.001). Conclusion: Endoscopic decompressive intervention within 8.5 hours of diagnosis of acute sigmoid volvulus decreased early volvulus recurrence, bowel ischemia and subsequent need for urgent surgical interventions. This in return decreased hospital length of stay and allowed for planned prophylactic surgical resection.Figure 1