Endoscopic reduction of gastric volvulus in a patient with hiatal hernia

Background: Gastric volvulus, characterized by twisting of the stomach over its axis, is an under-recognized complication of hiatal hernia. It is difficult to pass an endoscope through a volvulus, and hence, surgery is considered as the most common treatment modality. However, in this report, we provide a stepwise approach with images to provide therapeutic treatment via endoscopy with its role in the diagnosis of this condition. Case Presentation: We present the case of a 78-year-old female who presented with an acute episode of nausea and vomiting, associated with severe upper abdominal and mid-chest pain radiating to her back. Esophagogastroduodenoscopy showed the presence of gastric volvulus in the sac of a large hiatal hernia, which was confirmed on computed tomography. We avoided the need for an emergency surgery by successfully reducing the gastric volvulus via endoscopy under monitored anesthesia care and endotracheal intubation. Conclusion: Endoscopic reduction can be an effective therapy for the treatment of gastric volvulus, especially in patients who are poor surgical candidates.