Two Decades of Endoscopic Detorsion in Sigmoid Volvulus: Prognostic Factors for Failure from Two Tertiary Hospitals in Thailand Travel Award

Background Endoscopic detorsion is the first–line treatment for sigmoid volvulus. However, many patients experience failure, requiring emergency surgery with increased morbidity. Identifying predictive factors associated with failure is crucial for optimizing management and outcomes. Methods This retrospective cohort study analyzed 49 patients undergoing endoscopic detorsion for sigmoid volvulus at two Thai tertiary medical hospitals (2004–2024). Demographic, clinical, and radiologic data were collected. Regression analysis, directed acyclic graphs (DAGs), and receiver operating characteristic (ROC) analysis identified factors associated with detorsion failure. Results Endoscopic detorsion failed in 38.8% (n=19) of cases. Multivariable analysis identified BMI ≥ 18.5 kg/m² (adjusted OR: 0.12, 95% CI: 0.02–0.86, p = 0.035) as protective and cecal diameter ≥ 6.8 cm (adjusted OR: 5.35, 95% CI: 1.08–26.58, p = 0.040) as a risk factor. The failed detorsion group had a higher postoperative ostomy rate (61.1% vs. 4.5%, p < 0.001), with 72.7% remaining unclosed. Discussion Patients with cecal diameter ≥ 6.8 cm and BMI < 18.5 kg/m² are poor candidates for endoscopic detorsion and may benefit from early surgery. These findings support pre-procedural risk stratification to improve outcomes in sigmoid volvulus management.