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DOI: 10.1055/s-0033-1344567
Endoscopic detorsion for sigmoid volvulus using unsedated water-immersion colonoscopy
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Publication History
Publication Date:
05 September 2013 (online)
We report a simple method of endoscopic detorsion for sigmoid volvulus using unsedated water-immersion colonoscopy, which we currently use in the majority of our cases.
Importantly, volvulus detorsion with a colonoscope should be attempted only in patients with an absence of necrotic findings. Endoscopic detorsion is performed without fluoroscopic guidance. A cap or hood attached to the tip of the colonoscope, which maintains a distance between the instrument and the colonic wall, so keeping the luminal direction in view, is used to aid insertion [1]. The water-immersion method involves water infusion in lieu of air insufflation as the principal modality to decrease pain during insertion of the colonoscope [2] [3] [4]. Water is infused into the rectum through the biopsy port of the scope using two 50-mL disposable syringes or intermittently infused using a water-jet system. Removal of residual luminal air diminishes the boundary and improves the view. Water accumulates around the tip of the colonoscope and collapses the colon as previously described [2] [4].
The colonoscope is inserted with a twisting motion, according to the torsion of the sigmoid colon, and is typically passed under direct observation through the normal-caliber colon to the point of obstruction. This point classically appears as a termination of the lumen in a “whirl sign” [5]. Care needs to be taken to avoid air insufflation while gently attempting to pass the scope through the twisted segment ([Fig. 1 a]). If this process is successful, the distended proximal segment ([Fig. 1 b]) is decompressed using endoscopic suction, which often results in spontaneous detorsion. When liquid or soft stools flow out, the success of endoscopic detorsion is confirmed.
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In our experience the success rate of this treatment has been 100 %, therefore we believe an endoscopic detorsion is a reasonable treatment for elderly patients with sigmoid volvulus.
Endoscopy_UCTN_Code_TTT_1AQ_2AJ
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Competing interests: None
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References
- 1 Kondo S, Yamaji Y, Watabe H et al. A randomized controlled trial evaluating the usefulness of a transparent hood attached to the tip of the colonoscope. Am J Gastroenterol 2007; 102: 75-81
- 2 Mizukami T, Hibi T. How I teach my trainees “water navigation colonoscopy”. Am J Clin Med 2010; 7: 144-146
- 3 Leung FW, Amato A, Ell C et al. Water-aided colonoscopy: a systematic review. Gastrointest Endosc 2012; 76: 657-666
- 4 Mizukami T, Yokoyama A, Imaeda H et al. Collapse-submergence method: simple colonoscopic technique combining water infusion with complete air removal from the rectosigmoid colon. Dig Endosc 2007; 19: 43-47
- 5 Sugimoto S, Mizukami T, Morohoshi Y et al. Sigmoid volvulus associated with Chilaiditi’s syndrome. Intern Med 2013; 52: 515-516
Corresponding author
-
References
- 1 Kondo S, Yamaji Y, Watabe H et al. A randomized controlled trial evaluating the usefulness of a transparent hood attached to the tip of the colonoscope. Am J Gastroenterol 2007; 102: 75-81
- 2 Mizukami T, Hibi T. How I teach my trainees “water navigation colonoscopy”. Am J Clin Med 2010; 7: 144-146
- 3 Leung FW, Amato A, Ell C et al. Water-aided colonoscopy: a systematic review. Gastrointest Endosc 2012; 76: 657-666
- 4 Mizukami T, Yokoyama A, Imaeda H et al. Collapse-submergence method: simple colonoscopic technique combining water infusion with complete air removal from the rectosigmoid colon. Dig Endosc 2007; 19: 43-47
- 5 Sugimoto S, Mizukami T, Morohoshi Y et al. Sigmoid volvulus associated with Chilaiditi’s syndrome. Intern Med 2013; 52: 515-516
![](https://www.thieme-connect.de/media/endoscopy/2013S02/thumbnails/10-1055-s-0033-1344567-i554cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)