Comparison of endoscopic vacuum therapy with standard care for colorectal anastomotic leakage: a systematic review and meta-analysis

Background: This systematic review and meta-analysis aimed to evaluate the effectiveness of endoscopic vacuum therapy (EVT) compared with standard care in managing colorectal anastomotic leakage, a serious complication following colorectal surgery. Methods: We conducted a literature search across PubMed, Embase, and the Cochrane Library for clinical studies published before October 2024 that compared the outcomes of EVT and standard care for anastomotic leakage, including leakage resolution rates, treatment duration, hospital stay duration, or postoperative complications. The pooled estimates of risk ratio (RR) or mean difference were primarily derived using a fixed-effects model, with a random-effects model used when high heterogeneity was detected. Results: The analysis included six observational studies (273 patients). EVT was associated with a significantly higher resolution rate compared with standard care (RR 1.18, 95%CI 1.03 to 1.35; P = 0.02). Treatment duration was significantly shorter in the EVT group (mean difference −30.6 days, 95%CI −43.5 to −17.7; P < 0.001), while hospital stay duration showed no significant difference between EVT and standard care (mean difference 1.7 days, 95%CI −4.2 to 7.7; P = 0.57). No statistically significant difference was found in the rate of treatment-related complications between EVT and standard care (RR 1.17, 95%CI 0.52 to 2.80; P = 0.71). Conclusion: This meta-analysis suggests that EVT has superior effectiveness in terms of leakage resolution rates, as well as a shorter treatment duration compared with standard care for colorectal anastomotic leakage. This study is however constrained by the lack of prospective data, the risk of selection bias, and heterogeneity, requiring cautious interpretation of the findings.