Endoscopic negative-pressure therapy for anastomotic leaks after upper gastrointestinal surgery: systematic review...

UGI anastomotic leaks are severe postoperative complications associated with substantial morbidity, mortality, and prolonged hospitalization. EVT is a minimally invasive alternative to conventional approaches, but evidence has not been comprehensively synthesized.

This systematic review and meta-analysis was reported in accordance with the PRISMA 2020 statement. Observational studies (January 2015-January 2025) identified in PubMed, Embase, Cochrane, and LILACS. Adults with UGI anastomotic leaks treated with EVT were eligible. Random-effects models pooled proportions using the Freeman-Tukey double-arcsine transformation; sensitivity analyses used a logit transformation. Pre-specified subgroup analyses stratified by surgical indication (oncologic, bariatric, mixed), leak location (intrathoracic vs intra-abdominal), and risk of bias. Risk of bias was appraised using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series and certainty of evidence with GRADE.

Thirty-one studies (n = 767) were included. The pooled clinical success was 87% (95% CI, 82-91%) and remained high in sensitivity analyses (84-89%). No material differences were observed across oncologic, bariatric, or mixed series. Intrathoracic leaks showed lower success than intra-abdominal leaks (79 vs 95%). Thirty-day mortality was 7%, primarily in complex clinical contexts. Heterogeneity was substantial, and small-study effects were suspected. Overall certainty of evidence was rated low owing to observational design and risk of bias.

Across observational studies, EVT achieved high clinical success for UGI anastomotic leaks with low short-term mortality. Prospective cohorts and randomized trials are needed to refine indications, identify predictors of response, and assess cost-effectiveness.