Endoscopic Management of Anastomotic Insufficiencies in the Lower GI Tract

Anastomotic leaks and fistulas are a feared and challenging postoperative complication in colorectal surgery. Traditionally managed with protective ileostomy and revisional surgery, less-invasive endoscopic approaches are increasingly being utilized.

This article provides a comprehensive overview of current endoscopic treatment principles for managing anastomotic leaks after colorectal surgery. These approaches can be categorized into three main strategies: endoscopic negative pressure therapy - using negative pressure via polyurethane foam drains to promote wound healing and drain secretions; direct closure techniques - including endoscopic suturing systems (e.g., OverStitch) and clipping devices (e.g., over-the-scope clip) to approximate tissue and close defects; and vacuum stenting - a hybrid approach that combines negative pressure therapy with defect coverage using a covered self-expanding metal mesh stent (VAC-stent). Each method offers unique advantages depending on the leak characteristics and timing of detection. Early diagnosis and individualized treatment selection are critical to successful outcomes.

Endoscopic treatment of anastomotic insufficiencies represents a minimally invasive, effective and safe alternative to traditional surgical interventions, particularly in clinically stable patients.