Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?

Detalhes bibliográficos
Autor(a) principal: Rocha,Manuel Coelho da
Data de Publicação: 2020
Outros Autores: Capela,Tiago, Silva,Mário Jorge, Ramos,Gonçalo, Coimbra,João
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452020000300003
Resumo: Background: Colonic volvulus, mainly from the sigmoid, is a relatively common cause of intestinal obstruction, particularly in the elderly and in patients with debilitating conditions. The high morbi-mortality of emergency surgery places the endoscopic approach as the first-line treatment for the resolution of this acute obstructive condition. Objectives: To assess the importance of endoscopic treatment for the resolution of colonic volvulus in a debilitated population. Method: This is a retrospective analysis of emergency lower gastrointestinal endoscopies in patients with colonic volvulus as diagnosis, performed over a 9-year period (2009-2018), as well as population characterization and follow-up after the first exam. Results: We performed 88 procedures in 52 patients (56.4% males, median age 83 years, range 33-94). Endoscopic resolution was effective in 86.4% (76/88) of the exams, without procedure complications. Eighty-one percent of patients presented with volvulus recurrence, 50% of which occurred during the 3 months after the initial procedure. Twenty-one were submitted to surgery, 12 of which were emergency procedures after endoscopic failure as the primary treatment (5 of which had mucosal necrosis at endoscopy). There was no mortality in elective surgery. In the emergency plus necrosis group, mortality was 60% (3/5) and 14.3% (1/7) in the emergency without necrosis group. Conclusions: Despite the high recurrence of volvulus after endoscopic treatment, it seems to be an adequate and low-risk first-line therapy for sigmoid volvulus in debilitated patients, allowing improvement of surgical conditions.
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spelling Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?VolvulusSigmoidElderlyEndoscopySurgeryBackground: Colonic volvulus, mainly from the sigmoid, is a relatively common cause of intestinal obstruction, particularly in the elderly and in patients with debilitating conditions. The high morbi-mortality of emergency surgery places the endoscopic approach as the first-line treatment for the resolution of this acute obstructive condition. Objectives: To assess the importance of endoscopic treatment for the resolution of colonic volvulus in a debilitated population. Method: This is a retrospective analysis of emergency lower gastrointestinal endoscopies in patients with colonic volvulus as diagnosis, performed over a 9-year period (2009-2018), as well as population characterization and follow-up after the first exam. Results: We performed 88 procedures in 52 patients (56.4% males, median age 83 years, range 33-94). Endoscopic resolution was effective in 86.4% (76/88) of the exams, without procedure complications. Eighty-one percent of patients presented with volvulus recurrence, 50% of which occurred during the 3 months after the initial procedure. Twenty-one were submitted to surgery, 12 of which were emergency procedures after endoscopic failure as the primary treatment (5 of which had mucosal necrosis at endoscopy). There was no mortality in elective surgery. In the emergency plus necrosis group, mortality was 60% (3/5) and 14.3% (1/7) in the emergency without necrosis group. Conclusions: Despite the high recurrence of volvulus after endoscopic treatment, it seems to be an adequate and low-risk first-line therapy for sigmoid volvulus in debilitated patients, allowing improvement of surgical conditions.Sociedade Portuguesa de Gastrenterologia2020-06-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452020000300003GE-Portuguese Journal of Gastroenterology v.27 n.3 2020reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452020000300003Rocha,Manuel Coelho daCapela,TiagoSilva,Mário JorgeRamos,GonçaloCoimbra,Joãoinfo:eu-repo/semantics/openAccess2024-02-06T17:34:04Zoai:scielo:S2341-45452020000300003Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:36:11.287040Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?
title Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?
spellingShingle Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?
Rocha,Manuel Coelho da
Volvulus
Sigmoid
Elderly
Endoscopy
Surgery
title_short Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?
title_full Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?
title_fullStr Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?
title_full_unstemmed Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?
title_sort Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?
author Rocha,Manuel Coelho da
author_facet Rocha,Manuel Coelho da
Capela,Tiago
Silva,Mário Jorge
Ramos,Gonçalo
Coimbra,João
author_role author
author2 Capela,Tiago
Silva,Mário Jorge
Ramos,Gonçalo
Coimbra,João
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Rocha,Manuel Coelho da
Capela,Tiago
Silva,Mário Jorge
Ramos,Gonçalo
Coimbra,João
dc.subject.por.fl_str_mv Volvulus
Sigmoid
Elderly
Endoscopy
Surgery
topic Volvulus
Sigmoid
Elderly
Endoscopy
Surgery
description Background: Colonic volvulus, mainly from the sigmoid, is a relatively common cause of intestinal obstruction, particularly in the elderly and in patients with debilitating conditions. The high morbi-mortality of emergency surgery places the endoscopic approach as the first-line treatment for the resolution of this acute obstructive condition. Objectives: To assess the importance of endoscopic treatment for the resolution of colonic volvulus in a debilitated population. Method: This is a retrospective analysis of emergency lower gastrointestinal endoscopies in patients with colonic volvulus as diagnosis, performed over a 9-year period (2009-2018), as well as population characterization and follow-up after the first exam. Results: We performed 88 procedures in 52 patients (56.4% males, median age 83 years, range 33-94). Endoscopic resolution was effective in 86.4% (76/88) of the exams, without procedure complications. Eighty-one percent of patients presented with volvulus recurrence, 50% of which occurred during the 3 months after the initial procedure. Twenty-one were submitted to surgery, 12 of which were emergency procedures after endoscopic failure as the primary treatment (5 of which had mucosal necrosis at endoscopy). There was no mortality in elective surgery. In the emergency plus necrosis group, mortality was 60% (3/5) and 14.3% (1/7) in the emergency without necrosis group. Conclusions: Despite the high recurrence of volvulus after endoscopic treatment, it seems to be an adequate and low-risk first-line therapy for sigmoid volvulus in debilitated patients, allowing improvement of surgical conditions.
publishDate 2020
dc.date.none.fl_str_mv 2020-06-01
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dc.publisher.none.fl_str_mv Sociedade Portuguesa de Gastrenterologia
publisher.none.fl_str_mv Sociedade Portuguesa de Gastrenterologia
dc.source.none.fl_str_mv GE-Portuguese Journal of Gastroenterology v.27 n.3 2020
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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