Endoscopic sigmoidopexy for recurrent sigmoid volvulus in inoperable patients: a retrospective series of 15 patients.

BACKGROUND: Recurrent sigmoid volvulus is frequent and sometimes occurs in frail patients with contraindications to surgical sigmoidectomy. Percutaneous endoscopic sigmoidopexy (PES) has recently been proposed as an alternative to elective sigmoidectomy. We aimed to describe the efficacy and safety of PES. METHODS: All consecutive patients who underwent PES for recurrent sigmoid volvulus at two French centers between January 2017 and March 2021 were included in this retrospective case series. Recurrent sigmoid volvulus was defined as at least two symptomatic episodes treated by endoscopic decompression. Under endoscopic guidance, anchors were placed to attach the sigmoid to the anterior abdominal wall, allowing the placement of pigtail Chait catheters. RESULTS: 15 patients (60 % female; median age 74 years [range 49-96]) were included. Median number of previous sigmoid volvulus episodes was 3 (range 2-6). Procedures were technically successful with no intraprocedural adverse events for 14 patients (93 %). Peritonitis occurred at Day 2 in one patient (serious adverse event rate 7 %). Median follow-up time was 10 months (range 1-30). No sigmoid volvulus recurrence occurred during follow-up. CONCLUSION: PES using Chait catheters was feasible and effective for recurrent sigmoid volvulus and should be considered as an alternative to sigmoidectomy in inoperable patients.

[Knowledge of geriatric oncology in nursing homes: survey among healthcare professionals working in nursing homes in Pays-de-la-Loire.] / Connaissance de l'onco-gériatrie en Ehpad : enquête réalisée auprès des professionnels de santé dans les Ehpad des Pays-de-la-Loire.

OBJECTIVE: The increased incidence of cancer with age and rise of oral chemotherapy will affect the management of nursing home's residents. The aim of our study was to evaluate knowledge and practices in oncogeratric of nursing home's professionals from Pays-de-la-Loire and to raise awareness. METHODS: In partnership with UCOG-pl, OMEDIT and Observatoire du Cancer, we realised an observational survey from April to September 2017. Three questionnaires were sent to coordonary doctors (CD), nurses and paramedics, along with informative documents. RESULTS: In 589 nursing homes, 82 CD, 147 nurses and 240 paramedics gave an answer. The estimation of cancer's prevalence was 8,75%. Breast and prostate cancers were the most frequent. Nursing homes were an appropriate place to screen cancers by 79% of professionals. Some difficulties were reported by more than 80 % of them (coordination, residents' relationships...). At least, 20% of professionals couldn't define properly oncogeriatric. Only 73% of CD, 16% of nurses and 5% of paramedics knew about ongeriatric evaluations. Only 50% of CD knew about the G8 table, 15% of the oral cancer treatment file, 34% UCOG and 23% of the Observatoire du Cancer. Less than 5% of other professionals knew about this tool and these organisations. After information, most of the professionals think they will use them. Oral chemotherapy was already used by 90% of nurses, but the follow-up was considered inadequate. DISCUSSION: Our survey shows a low awareness about oncogeriatric by the nursing home's professionals. This misreading and under-diagnosis of cancer in nursing homes could partly explain by the lake of training, communication and coordination with oncology professionals and the distinctive characteristics of nursing home's residents. Study suggests that raising awareness of oncogeriatric and its challenges to all professionals would improve the care of the elderly with cancer.

Outcomes of first-line endoscopic management for patients with sigmoid volvulus.

BACKGROUND: Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery. AIM: The aim of this study was to compare death rate between elective sigmoidectomy and conservative management following endoscopic detorsion for sigmoid volvulus. METHODS: The medical records of 83 patients undergoing endoscopic detorsion of a sigmoid volvulus from 2008 to 2014 were retrospectively reviewed. Patients were divided into two groups: 'elective surgery' and 'no surgery'. RESULTS: Patients in the 'no surgery' group (n = 42) were older and had more loss of autonomy than in the 'elective surgery' group. Volvulus endoscopic detorsion was successful in 96% of patients with no complications. The median follow-up was 13 months (1 day-67 months). The death rate was 62% in the 'no surgery' group versus 32% in the 'elective surgery' group (p = 0.02). In the 'no surgery' group, 23/42 of patients had volvulus recurrence. No recurrence occurred after surgery. CONCLUSION: Elective surgery must be planned as soon as possible after the first episode of sigmoid volvulus. In frail patients, other options must be developed.