Percutaneous Endoscopic Sigmoidopexy for Recurrent Sigmoid Volvulus: A Systematic Review of Efficacy, Safety, and Clinical Outcomes.

Sigmoid volvulus represents a significant clinical challenge, particularly in elderly patients with multiple comorbidities who experience recurrent episodes following initial endoscopic decompression. While definitive surgical resection remains the gold standard for preventing recurrence, many patients are unsuitable for major abdominal surgery due to advanced age, medical frailty, or elevated surgical risk. Percutaneous endoscopic sigmoidopexy has emerged as a minimally invasive alternative that involves endoscopically guided fixation of the sigmoid colon to the anterior abdominal wall, thereby restricting colonic mobility and preventing the anatomical conditions necessary for volvulus formation. This systematic review comprehensively evaluates the available evidence on this technique for preventing recurrent sigmoid volvulus. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched major databases and identified five studies comprising fourteen patients who underwent the procedure. The patient population was uniformly elderly and medically complex, with multiple prior volvulus episodes. Technical approaches varied considerably across studies, including different fixation devices, numbers of anchors, spatial configurations, and use of fluoroscopic guidance. Notably, no recurrences were documented during follow-up, though duration varied markedly across studies. Based on this limited sample, the complication profile was generally favorable, with most adverse events being minor and self-limiting, though procedure-related mortality occurred in patients with severe underlying comorbidities. While the evidence base remains limited to small case series and reports, the findings suggest that percutaneous endoscopic sigmoidopexy may represent a viable option for carefully selected high-risk patients with recurrent sigmoid volvulus who are unsuitable for or decline definitive surgical intervention.