Efficacy of improvised EndoVAC versus covered stent in colorectal anastomotic leaks: A multicenter study with a propensity analysis.

Abstract

Introduction and aims: Colorectal anastomotic leak (AL) occurs in up to 25% of cases and is the leading cause of postoperative morbidity and mortality. Self-expanding metallic stents (SEMSs) and endoscopic vacuum therapy (EVT) have recently emerged as therapeutic options. Our aim was to compare EVT and SEMS success rates in the treatment of AL, in patients with and without protective diverting ostomy.

Materials and methods: A retrospective study was conducted at three oncology centers in Medellín, Colombia, within the time frame of January 2006 and December 2022. Fifty-four patients with AL, treated with either EVT or SEMS were included. Groups were matched 1:1 by age (±3 years), body mass index (BMI ± 3 kg/m²), and leak size.

Results: There were no significant differences between the two groups in baseline characteristics, leak size and location, time from surgery to treatment (P = .11), tumor stage, or surgical approach. The EVT group required more procedures (4.6 ± 3.1 vs 2.1 ± 1.6; P = .047), but was associated with fewer additional interventions (P = .035), shorter hospital stay (41 ± 16 vs 52 ± 23 days; P = .017), higher leak resolution rate (89% vs 67%; P = .049), higher ostomy reversal rate (83% vs 55%; P = .053), and a trend toward improved survival (log-rank P = .050).

Conclusion: EVT was associated with better clinical outcomes, compared with SEMS. Larger studies are needed to confirm our findings.