Introduction- Acute colonic volvulus (ACV) is a gastrointestinal emergency that results from the torsion of a segment of the colon either at the level of the sigmoid colon or cecum. It can lead to severe complications such as bowel infarction and peritonitis which can increase mortality. The COVID-19 pandemic has led to a significant reduction in endoscopic utilization globally. However, the data about endoscopy utilization in a gastrointestinal emergency such as ACV is not non-existent. Hence, we attempted to evaluate the rates of endoscopy utilization in 2020 compared to 2019 for ACV patients.
Methods- We used TriNetX, a federated cloud-based network comprising of 92 healthcare organizations (HCOs) across the US. All adult patients admitted with ACV in the year 2020, were compared to the ACV patients hospitalized in 2019. Patients with pseudocolonic obstruction and megacolon were excluded. The primary outcomes were rates of endoscopy (sigmoidoscopy/colonoscopy) utilization and all-cause 30-day mortality. The clinical outcomes were measured after 1:1 propensity matching of the groups based on the baseline demographics and comorbidities.
Results- A total of 5,624 patients were hospitalized with ACV in 2020 compared to 21,119 patients in 2019 with a reduction of 73.4%. Comorbidites of these patients at presentation, laboratory findings, and clinical outcomes are noted in Table 1. The mean age at presentation was 66.7 years (SD- 15.6 years). Patients with obesity, chronic use of opioid medications, and laxatives had a higher risk of ACV. After matching, rates of endoscopy utilization (risk ratio [RR]- 1.2 (CI- 0.77 - 1.82)), abdominal cross-sectional imaging rates (RR 0.96 (CI- 0.54 – 1.70)) did not differ between two groups. Furthermore, no change in mortality was noted in the 2020 ACV group compared to the 2019 group (RR- 1.01 (0.78 – 1.34)).
Discussion- The rates of ACV reduced significantly by 73.4% in 2020 compared to 2019. Despite the potential risk of infection transmission, the utilization of endoscopy, abdominal cross-sectional did not differ during the pandemic. Chronic use of opioids continues to be a major risk factor for ACV. Furthermore, there was no change in mortality rates in ACV 2020 compared to ACV 2019. Larger studies are needed to validate these findings.
Reference: Perisetti, A., Gajendran, M., Boregowda, U., Bansal, P., & Goyal, H. (2020). COVID‐19 and gastrointestinal endoscopies: current insights and emergent strategies. Digestive Endoscopy, 32(5), 715-722
Perisetti, Abhilash MD; Goyal, Hermant MD; Mahanazuddin, Syed PhD; Chandan, Saurabh MD; Allala, Ruthvik BA; Rojas, Mariajose MD; Kopel, Jonathan PhD; Sachdeva, Sonali MBBS; Aloysius, Mark M. MD, PhD; Tharian, Benjamin; and Sharma, Neil MD, "Effect of Pandemic on Endoscopic Utilization in Colonic Volvulus: A Global Multicentric Study" (2021). Other Specialties. 27.