Vol.:(0123456789) 1 3 Langenbeck's Archives of Surgery (2023) 408:338 https://doi.org/10.1007/s00423-023-03071-4 RESEARCH Endoscopic management of acute sigmoid volvulus in high risk surgical elderly patients: a randomized controlled trial Said Negm 1  · Ahmed Farag 1  · Ahmed Shafiq 1  · Adel Moursi 1  · Amr A. Abdelghani 1 Received: 6 December 2022 / Accepted: 15 August 2023 © The Author(s) 2023 Abstract Background Most patients with sigmoid volvulus are of old age with multiple comorbidities. So, the risk of surgery for those elderly patients is usually associated with increased rates of morbidity and mortality. Early intervention is required for manag- ing sigmoid volvulus to avoid its serious complications; therefore, early endoscopic untwist of sigmoid colon can be performed followed by endoscopic fixation of sigmoid colon under sedation in this category of the patients to avoid development of high risk surgical complications following surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy procedure to relieve obstruction. Methods This prospective randomized controlled clinical trial included all patients who developed acute sigmoid volvulus and were referred to the Zagazig University Hospital Emergency Department between December 2020 and August 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9989/23-10-2022) and was retrospectively submitted in http://clinicaltrials.gov in November 2022 (http://clinicaltrials.gov ID: NCT05620446). Included eligible patients were simply randomized at a 1:1 ratio to “Endoscopic Group (EG)” or “Surgical Group (SG)” via drawing of sealed envelopes containing computer-generated random numbers prepared by a third party before start of intervention. Results Sample size included 18 patients divided into 2 equal groups. (1) Endoscopic group included 9 patients who were subjected to endoscopic untwist of sigmoid colon followed by endoscopic fixation of sigmoid colon under sedation; (2) Surgical group included 9 patients who were subjected to surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy under general anesthesia. In comparison between both groups, there were statistically significant differences regarding length of hospital stay and procedure time. Unfortunately, there were no statistically significant differences regarding postopera- tive complications and co-morbidities. Eight patients in the endoscopy group demonstrated excellent quality of life, and one demonstrated good quality of life; unlike the surgical group, there were 3 patients with excellent quality of life, 5 patients with good quality of life, and 1 patient with poor quality of life. So there was statistically significant difference regarding quality of life between both groups. During the 9-month follow-up period, both groups demonstrated no cases of recurrence post-fixation. Conclusion Endoscopic management of acute sigmoid volvulus is effective and safe in elderly high risk surgical patients (either in managing the intestinal obstruction caused by volvulus or in definitive treatment of volvulus). Keywords Sigmoid volvulus · Endoscopy · Intestinal obstruction · Loop colostomy · Sigmoid fixation · Sigmoid excision Introduction Sigmoid volvulus is a surgical emergency and if left untreated, it results in bowel ischemia and perforation with high mortality rates [1]. Moreover, surgical management of sigmoid volvulus may be associated with increased rates of morbidities and mortalities, particularly in elderly patients with multiple comorbidities [2]. In order to decrease serious complications in previously mentioned group of patients, the earliest and least invasive interventions should be utilized [3]. The deflating rectal tube procedure was performed to untwist sigmoid volvulus; however, if it fails, two-step sur- gery should be performed: (a) emergency surgical simple loop colostomy to relieve intestinal obstruction; (b) defini- tive surgery to restore colonic continuity [4]. The minimally invasive “endoscopic approach” has become first line of * Said Negm said.negm@outlook.com Extended author information available on the last page of the article