Efficacy of endoscopic vacuum therapy for the treatment of colorectal anastomotic leaks

Anastomotic leak is a frequent and a threatening complication following colorectal surgery, and it is associated with early- and long-term morbidity and mortality. Anastomotic leak can be managed with surgical or conservative approaches; clinically stable patients without generalized peritonitis may be managed endoscopically with a view to reducing surgery-related morbidity. A novel minimally invasive approach is the endoscopic vacuum therapy (EVT) that is indicated to treat large anastomotic leaks associated with extraluminal infected cavities. It is based on the application of a local negative pressure inside the extraluminal cavity in order to drain, to induce granulation of the tissue with subsequent leak healing by secondary intention. We performed a review of the literature on the use of EVT in the treatment of colorectal anastomotic leaks. Mean success rate was 81%; the presence of a derivative stoma and early onset of the therapy seem to be positive predicting factor. Few major complications requiring discontinuation of the treatment and no mortality related to the procedure were reported. EVT represents promising alternative to surgery in the treatment of selected cases of anastomotic leak, with few complications and high success rate.