Clin Endosc.  2023 May;56(3):340-352. 10.5946/ce.2022.166.

Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States

  • 1Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
  • 2Department of Gastroenterology, Parkview Cancer Institute, Fort Wayne, IN, USA
  • 3The Wright Center for Graduate Medical Education, Scranton, PA, USA
  • 4Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
  • 5Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
  • 6Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
  • 7Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI, USA
  • 8Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
  • 9Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, USA


Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States.
We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared.
From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management.
Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.


Colonic volvulus; Endoscopy; Mortality; Surgery; Trends


  • Fig. 1. Trends of Charlson comorbidity index (CCI) for colonic volvulus-related hospitalizations in the United States from 2007 to 2017.

  • Fig. 2. Trends of inpatient mortality, opioid use, and chronic constipation for colonic volvulus-related hospitalizations in the United States from 2007 to 2017.

  • Fig. 3. Comparison of Charlson comorbidity index (CCI) for endoscopic and surgical management of colonic volvulus-related hospitalizations in the United States from 2007 to 2017.


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