Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: A systematic review

Abstract

Introduction Anastomotic leakage (AL) after low anterior resection for rectal cancer is a severe complication. Except for re‐operation, several endoscopic options have been proposed for the minimal invasive treatment of AL, including the endoluminal vacuum devices, tissue sealants and Over‐The‐Scope‐Clip (OTSC) technique. The aim of the present review is to evaluate the effect of alternative treatment options for AL repair, by means of endoscopy. Method A bibliographic search was performed in the international literature. Ten case reports and series were finally included, reporting 75 cases of endoscopic repair of AL. A descriptive statistical analysis and a systematic review were performed. Results The patients' mean age was 65.84 ± 9.92 years (95% CI: 61.70‐68.76), the male‐to‐female ratio being 1.5:1. The mean diameter of the cavity was 5.17 ± 3.32 cm (95% CI: 4.03‐6.31). The mean time until the diagnosis was 44.15 ± 105.91 days (95% CI: 13.39‐74.90). Vacuum‐assisted closure therapy was the most common technique (52%), followed by fibrin glue (25.3%) and OTSC (22.7%). As supplementary therapy, OTSC was applied in 8.3%, vacuum‐assisted closure in 25%, endoclips in 4.2%, while fibrin glue was the most frequently used (62.5%). Conclusion Endoscopic management of AL after low anterior resection is considered as an alternative to surgical treatment with promising results.

Endoscopic vacuum therapy for in- and outpatient treatment of colorectal defects

“…Therefore, a safe, effective, and well-validated minimally invasive technique is urgently needed in order to attain the best possible short- and long-term outcomes. Even though data are still scarce, EVT has become the most common endoscopic technique for treatment of colorectal leaks after rectal resection [ 5 ], and currently, commercial systems are distributed in more than 40 countries worldwide [ 5 , 6 ]. Compared to stent application or fibrin glue, EVT appears to be a much more versatile endoscopic technique because it allows for the treatment of defects in almost all extraperitoneal locations, regardless of location or size of the defect.…”

“…Today, EVT is the most commonly used technique for endoscopic treatment of postoperative surgical leaks. Commercial systems for EVT are distributed in more than 40 countries worldwide [5,6]. However, existing evidence on EVT for colorectal defects is still based on a and Other Interventional Techniques An abstract of this study entitled "Endoscopic Vacuum Therapy for Colorectal Defects: 20 Years of Experience for In-and Outpatient Treatment" (# 2020-SF-1157-ACS) was accepted as oral presentation in the Scientific Forum at Clinical Congress 2020 in Chicago, IL.…”

“…Today, EVT is the most commonly used technique for endoscopic treatment of postoperative surgical leaks. Commercial systems for EVT are distributed in more than 40 countries worldwide [ 5 , 6 ]. However, existing evidence on EVT for colorectal defects is still based on a few, small patient series from various institutions, employing different methods, treatment algorithms and materials [ 7 ].…”

Treatment Modalities for Anastomotic Leakage in Rectal Cancer Surgery

“…A recent review found more options for endoscopic treatment, but most studies are difficult to compare because of the small sample size and variety in treatments and patients. 35 Endoscopic injection with fibrin glue into the anastomotic cavity can be used to close the defect and is mostly used for closing small leaks (<5 mm) or fistulae. 36,37 It can be utilized as an addition to prior treatment, to close a small remaining defect.…”

“…An anastomotic defect can be overcome by over the scope clipping (OTSC) and standard clips used for regular endoscopy to control bleeding or perforation can be used. 35 OTSC can be used in combination with other techniques (e.g., EVAC treatment) and is mainly suitable for small defects (<15 mm).…”