Through the looking glass: Endoscopic management of anastomotic leaks

Anastomotic leak after colorectal resection is a feared complication that dramatically worsens mortality and anastomotic survival. In this chapter, we describe the evolving field of endoscopic management of anastomotic leaks. Endoscopic management of anastomotic leaks is suitable for a minority of leaks that meet the following criteria: 1) the patient is clinically well; 2) the leak is contained; 3) the leak has no drainable component, and; 4) the leak has failed clinical observation. Distinguishing a chronic abscess from a well-drained, chronic sinus is paramount to selection for safe use of endoscopic approaches. Endoscopic techniques for appropriate anastomotic leaks include marsupialization of the tract, over-the-scope endoclips, covered stents, and vacuum-assisted closure. The use of each technique can be supported when selecting for the appropriate anatomic circumstances.