A novel application of the water exchange method in the treatment of sigmoid volvulus: a report of two cases.

Water immersion for colonoscopy was originally developed as an adjunct to air insufflation. It facilitated passage through the sigmoid colon and decreased cecal intubation time. From this technique evolved the water exchange method for screening and diagnostic colonoscopies. Water exchange uses cycles of warm water infusion and suction during insertion in lieu of air insufflation to avoid over-distension of the colon. In this report, we describe a novel application of the water exchange method in the effective and safe treatment of sigmoid volvulus in two patients. In both cases, the patients tolerated the procedure well and did not require sedation. Controlled water exchange allowed for mucosal visualization without exacerbating the trapped air proximal to the volvulus, potentially decreasing the risk of perforation. Our findings suggest that the water exchange method is an effective and safe practice for endoscopic detorsion of acute, nonstrangulated sigmoid volvulus.