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The following is a summary of “Effect of the timing of endoscopic detorsion on clinical outcomes in patients with sigmoid volvulus,” published in the January 2025 issue of Gastroenterology by Aminov et al.

Current guidelines recommend endoscopic detorsion for managing sigmoid volvulus without ischemia or perforation, yet the optimal timing for this intervention remains undefined. In this retrospective study, admissions for sigmoid volvulus treated with endoscopic detorsion from January 2010 to April 2024 were analyzed to evaluate the relationship between the timing of detorsion and patient outcomes. Timing was calculated as the interval between confirmatory radiologic examination and the procedure. A total of 118 episodes from 73 adult patients (mean age 69.0 years, 76.3% male) were reviewed. The median time to endoscopic detorsion was 225.5 minutes (IQR 144.5–478.3), with 81 cases (68.6%) completed within 6 hours. Timing of detorsion showed no significant association with ischemia (p=0.289) or a combination of serious adverse outcomes (p=0.777). 

Delayed detorsion (>6 hours) was more common among younger patients (mean age 62.4 vs. 67.4 years, p=0.034) and those with rectal tube placement (59.5% vs. 21.0%, p<0.001). While delayed detorsion was linked to a longer hospital stay (median 5.0 vs. 3.0 days, p=0.011), other outcomes—including procedural success, ischemia, readmission rates, and mortality—did not differ significantly between early and delayed cases. Multivariate regression identified “on call” status as a significant predictor of serious outcomes (p=0.045), whereas the timing of detorsion was not (p=0.404). These findings suggest that a delay in endoscopic detorsion does not adversely impact major clinical outcomes, except for prolonged hospitalization. Therefore, urgent intervention may not always be necessary, potentially allowing flexibility in clinical decision-making for managing sigmoid volvulus.

Source: sciencedirect.com/science/article/abs/pii/S0016510725000471