Tantinam Thanat, Buakhrun Suradet, Chandrachamnong Punnawat, Bhatanaprabhabhan Kullawat, Thiengthiantham Rangsima, Sutharat Pawit, Sanmee Suwan, Supatrakul Ekkarin, Ngamsirimas Boonchai, Santrakul Nataphon
Surgical Unit, Phatthalung Hospital, Mueang Phatthalung, 93000, Thailand.
Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand.
Surg Endosc. 2025 Jul 14. doi: 10.1007/s00464-025-11971-3.
Endoscopic detorsion is the first-line treatment for sigmoid volvulus. However, a significant proportion of patients experience treatment failure, requiring emergency surgery, which is associated with increased morbidity. Identifying predictive factors for detorsion failure is crucial for optimizing management strategies and improving patient outcomes.
This retrospective cohort study analyzed 49 patients who underwent endoscopic detorsion for sigmoid volvulus at two tertiary hospitals in Thailand from 2004 to 2024. Demographic, clinical, and radiologic data were collected. Regression analysis, directed acyclic graphs (DAGs), and receiver operating characteristic (ROC) analysis were used to identify factors associated with detorsion failure.
Of the 49 patients who underwent endoscopic detorsion, 19 (38.8%) experienced treatment failure. Multivariable regression analysis identified BMI ≥ 18.5 kg/m2 as associated with lower odds of detorsion failure (adjusted OR: 0.12, 95% CI 0.02-0.86, p = 0.04). Cecal diameter ≥ 6.8 cm was associated with increased failure risk (adjusted OR: 5.35, 95% CI 1.08-26.58, p = 0.04). Patients in the failed detorsion group had a significantly higher rate of postoperative ostomy creation (61.1% vs. 4.5%, p < 0.001), with 72.7% of these ostomies remaining unclosed.
Our findings suggest that patients with a cecal diameter ≥ 6.8 cm and BMI < 18.5 kg/m are poor candidates for endoscopic detorsion and should be considered for early surgical intervention.
内镜下扭转复位术是乙状结肠扭转的一线治疗方法。然而，相当一部分患者治疗失败，需要急诊手术，这与发病率增加相关。识别扭转复位失败的预测因素对于优化管理策略和改善患者预后至关重要。
这项回顾性队列研究分析了2004年至2024年在泰国两家三级医院接受乙状结肠扭转内镜下扭转复位术的49例患者。收集了人口统计学、临床和放射学数据。采用回归分析、有向无环图（DAG）和受试者工作特征（ROC）分析来识别与扭转复位失败相关的因素。
在接受内镜下扭转复位术的49例患者中，19例（38.8%）治疗失败。多变量回归分析确定BMI≥18.5kg/m²与扭转复位失败几率较低相关（调整后的OR：0.12，95%CI 0.02-0.86，p=0.04）。盲肠直径≥6.8cm与失败风险增加相关（调整后的OR：5.35，95%CI 1.08-26.58，p=0.04）。扭转复位失败组患者术后造口形成率显著更高（61.1%对4.5%，p<0.001），其中72.7%的造口未闭合。
我们的研究结果表明，盲肠直径≥6.8cm且BMI<18.5kg/m²的患者不太适合内镜下扭转复位，应考虑早期手术干预。
