LAUSR

11.8 mm and the width of the side-hole tube is around 12 mm [2]. In some patients with tight anal tone, I would insert the tube first followed by the colonoscope to prevent excessive anal dilatation and discomfort. It is also relevant that many patients with a sigmoid volvulus (SV) have diminished anal tone. Therefore, in my practice, severe anal discomfort during the procedure is uncommon. Second, I agree with his comments regarding tube insertion. For colonoscopic decompression in SV patients, the colonoscope passing through the two twisting points of the sigmoid colon is the key point. However, it is not easy to assure the definite twisting point on the monitor. The reliable marker is the clinical symptoms and signs. In my clinical practice, there would be significant relief of the abdominal distention and pain whenever the colonoscope is passed through the twisting points. Then, we can leave the side-hole tube in place for decompression. Third, regarding early SV recurrence, in our preliminary report of 13 patients treated by colonoscopic decompression plus side-hole tube placement, no SV recurrence and no tube displacement occurred during the hospitalization period. In my opinion, multiple side-hole creations are the important points to prevent early SV recurrence. Traditionally, the rubber tube we used for decompression was an end-tube without sideholes, which is easily blocked. Once the tube is obstructed by food material or stool, there would be no function for decompression and SV recurrence is inevitable. However, after discharge, five patients had SV recurrence in the nursing institution within 6 months and repeated tube placement was performed. Therefore, the method we proposed in the paper (colonoscopic decompression followed by snare-assisted side-hole tube placement for SV) is an effective method for temporary relief. In my opinion, surgical resection is still the treatment of choice for repeated SV. I am grateful to Dr Atamanalp for his comments.