title: Effectiveness and clinical results of endoscopic management of sigmoid volvulus using unsedated water-immersion colonoscopy.
abstract: OBJECTIVE
  Although intestinal obstruction as a result of sigmoid volvulus (SV) may be successfully resolved using endoscopic detorsion, surgical treatment remains the main therapeutic strategy. We evaluated the endoscopic detorsion procedure using unsedated water-immersion colonoscopy for the treatment of SV.
  
  
  METHODS
  A retrospective chart review was conducted on the clinical background and prognosis of 21 SV patients who underwent 71 endoscopic detorsion procedures using unsedated, water-immersion colonoscopy.
  
  
  RESULTS
  In all, 14 (67%) male and seven (33%) female patients, with a mean age of 73 years (range, 54-95 years) were enrolled; 86% were >70 years of age. Among these patients, 90% had a background of key predisposing factors. In the 21 patients, endoscopic detorsion was successfully done using unsedated water-immersion colonoscopy. SV recurred in 10 patients at a median of 180 days. Endoscopic detorsion for recurrent SV was successfully achieved in all cases, and none of the secondary cases became severe. Only male patients were observed to experience three or more recurrent episodes of SV.
  
  
  CONCLUSIONS
  SV occurred most commonly in elderly patients with a surgical risk. Our experience suggests that conservative endoscopic treatment using unsedated water-immersion colonoscopy is a safe, reasonable, conservative endoscopic approach for elderly patients in the absence of necrotic findings. We currently use this procedure in most of our cases.
authors.affiliation: Department of Gastroenterology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Sugimoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Hosoe
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mizukami
authors.forename: Yuya
authors.initials: Y
authors.lastname: Tsunoda
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ito
authors.forename: Satoshi
authors.initials: S
authors.lastname: Imamura
authors.forename: Toshihide
authors.initials: T
authors.lastname: Tamura
authors.forename: Shuichi
authors.initials: S
authors.lastname: Nagakubo
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Morohoshi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Koike
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Fujita
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Komatsu
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D012809:Colon, Sigmoid; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007101:Immersion; D045822:Intestinal Volvulus / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014867:Water
chemical_list: D014867:Water
keywords: endoscopic detorsion; intestinal obstruction; recurrence; sigmoid volvulus; water immersion