Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: A systematic review

Introduction Anastomotic leakage (AL) after low anterior resection for rectal cancer is a severe complication. Except for re‐operation, several endoscopic options have been proposed for the minimal invasive treatment of AL, including the endoluminal vacuum devices, tissue sealants and Over‐The‐Scope‐Clip (OTSC) technique. The aim of the present review is to evaluate the effect of alternative treatment options for AL repair, by means of endoscopy. Method A bibliographic search was performed in the international literature. Ten case reports and series were finally included, reporting 75 cases of endoscopic repair of AL. A descriptive statistical analysis and a systematic review were performed. Results The patients' mean age was 65.84 ± 9.92 years (95% CI: 61.70‐68.76), the male‐to‐female ratio being 1.5:1. The mean diameter of the cavity was 5.17 ± 3.32 cm (95% CI: 4.03‐6.31). The mean time until the diagnosis was 44.15 ± 105.91 days (95% CI: 13.39‐74.90). Vacuum‐assisted closure therapy was the most common technique (52%), followed by fibrin glue (25.3%) and OTSC (22.7%). As supplementary therapy, OTSC was applied in 8.3%, vacuum‐assisted closure in 25%, endoclips in 4.2%, while fibrin glue was the most frequently used (62.5%). Conclusion Endoscopic management of AL after low anterior resection is considered as an alternative to surgical treatment with promising results.