Endoscopic Solutions for Colorectal Anastomotic Leaks

Abstract

Anastomotic leakage is the most important postoperative complication following colorectal anastomoses. Endoscopic techniques are newly implemented and are somewhat in between options that can be considered for the treatment of AL in selected cases. Aim of this literature review is to present, analyze, and synthesize material from diverse sources to provide a comprehensive summary of the endoscopic procedures available for the treatment of fistula following LAR for rectal cancer. A bibliographic search was carried out on Pubmed for articles published until 31th January 2021. Two hundred thirteen articles were screened and after a proper assessment thirty-four articles were left for the scopes of this narrative review. The most commonly applied endoscopic solutions are the transrectal vacuum-assisted closure (VAC), the Over-The-Scope clipping system (OTSC) and the OverStitch suturing system. They all seem to offer integrate solutions in the management of colorectal anastomotic leaks. Early detection of anastomotic leak might increase the success rate of endoscopic techniques, reducing overall healing time and length of hospital stay. Endoscopic evaluation could be added as an adjunctive screening test to all those patients who are suspected of an early postoperative colorectal leak, in order to confirm the suspicion and to promptly start the endoscopic treatment.