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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(09): E1342-E1349
DOI: 10.1055/a-1490-8783
Original article

Endo-sponge in management of anastomotic colorectal leaks: a systematic review and meta-analysis

Banreet S. Dhindsa
2   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha Nebraska, United States
,
Yassin Naga
3   University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, United States
,
Syed M. Saghir
3   University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, United States
,
Sarav Gunjit Singh Daid
4   Metropolitan Hospital Center/New York Medical College, New York, New York, United States
,
Saurabh Chandan
5   Creighton University Medical Center, Omaha, Nebraska, United States
,
Harmeet Mashiana
2   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha Nebraska, United States
,
Amaninder Dhaliwal
6   Division of Gastroenterology and Hepatology, Moffitt Cancer Center, Tampa, Florida, United States
,
Abhitej Sidhu
7   Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India
,
Harlan Sayles
8   Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Daryl Ramai
9   Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, United States
,
Ishfaq Bhat
2   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha Nebraska, United States
,
Shailender Singh
2   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha Nebraska, United States
,
Stephanie McDonough
1   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Douglas G. Adler
1   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Abstract

Background and study aims Following colorectal surgery, anastomotic dehiscence and leak formation has an incidence of 2 % to 7 %. Endo-SPONGE has been applied in the management of anastomatic leaks (ALs) after colorectal surgery. This is the first systematic review and meta analysis to evaluate the efficacy and safety of Endo-SPONGE in the management of colorectal ALs.

Patients and methods The primary outcomes assessed were the technical and clinical success of Endo-SPONGE placement in colorectal ALs. The secondary outcomes assessed were the overall adverse events (AEs) and the AE subtypes. Pooled estimates were calculated using random-effects models with 95 % confidence interval (C. I.). The statistical analysis was done using STATA v16.1 software (StataCorp, LLC College Station, Texas, United States).

Results The analysis included 17 independent cohort studies with a total of 384 patients. The rate of technical success was 99.86 % (95 % CI: 99.2 %, 100 %; P = 0.00; I2  = 70.69 %) and the calculated pooled rate of clinical success was 84.99 % (95 % CI: 77.4 %, 91.41 %; P = 0.00; I2  = 68.02 %). The calculated pooled rate of adverse events was 7.6 % (95 % CI: 3.99 %, 12.21 %; P = 0.03; I2  = 42.5 %) with recurrent abscess formation and bleeding being the most common AEs. Moderate to substantial heterogeneity was noted in our meta-analysis.

Conclusions Endoscopic vacuum therapy appears to be a minimally invasive, safe, and effective treatment modality for patients with a significant colorectal leak without any generalized peritonitis with high clinical and technical success rates and a low rate of adverse events. Further prospective or randomized controlled trials are needed to validate our findings.

Supplementary material



Publication History

Received: 05 January 2021

Accepted: 29 March 2021

Article published online:
16 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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