Endoscopic treatment of postsurgical colorectal anastomotic leak (with videos)

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

“…There were a total of nine case series or cohort studies including 58 patients who had their anastomotic leaks managed with stents (Table 1) [5, 17–24]. Long-term salvage rates were reported between 50 and 100%, which in most cases was defined as evidence of closure at time of removal of the stent or follow-up endoscopy.…”

“…15–20 cm from anal vergeDiMaio [21]Case seriesColorectal5‘When surgical diversion was deemed necessary’60% Fibrin glue ( n  = 3) +/- clip ( n  = 1) at time of stenting20% ( n  = 1) after diagnosis of leak and failed stentPercutaneous drain placement to abscess 80%80% ( n  = 4)Pain requiring admission or stent removal 60%Stent migration 40% (mean day 8)Period of stent placement—median 20 daysLamazza [22]Prospective cohortColorectal22Leak confirmed on gastrograffin enema27.30% ( n  = 6) further stent after spontaneous expulsion68% ( n  = 15) after diagnosis of leak9% ( n  = 2) closure of rectovaginal fistula86.4% ( n  = 19)All leaks at leaks > 30% circumferenceMean 24-month follow-upMortality 0%Anorectal pain/tenesmus 0%Stoma closure rate 86.4%Manta [23]Case seriesColorectal4‘Patients referred to the endoscopy unit’100% ( n  = 4) clips to close defect prior to stentNot stated75% ( n  = 2, operative intervention, n = 1 percutaneous drain)50% ( n  = 2)Mean diameter of defect 35 mmPerez [24]Case seriesColorectal2Patients declined surgery50% ( n  = 1) VAC therapy for 2 weeks100% clips to secure stent50% ( n  = 1) at primary surgery0%100%Stent migration 0%Mean time to closure − 14 weeks …”