Abstract
BackgroundDuring the last two decades, vacuum-assisted wound therapy has been successfully transferred to an endoscopic treatment approach of various upper and lower gastrointestinal leaks called endoscopic vacuum therapy (EVT). As mostly small case series are published in this field, the aim of our systematic review and meta-analysis was to evaluate the efficacy and safety of EVT in the treatment of colorectal leaks.MethodsA systematic search of MEDLINE/PubMed and Cochrane databases was performed using search terms related to EVT and colorectal defects (anastomotic leakage, rectal stump insufficiency) according to the PRISMA guidelines. Randomized controlled trials (RCTs), observational studies, and case series published by December 2020 were eligible for inclusion. A meta-analysis was conducted on the success of EVT, stoma reversal rate after EVT as well as procedure-related complications. Statistical interferences were based on pooled estimates from random effects models using DerSimonian-Laird estimator.ResultsOnly data from observational studies and case series were available. Twenty-four studies reporting on 690 patients with colorectal defects undergoing EVT were included. The mean rate of success was 81.4% (95% CI: 74.0%–87.1%). The proportion of diverted patients was 76.4% (95% CI: 64.9%–85.0%). The mean rate of ostomy reversal across the studies was 66.7% (95% CI: 58.0%–74.4%). Sixty-four patients were reported with EVT-associated complications, the weighted mean complication rate across the studies was 12.1% (95% CI: 9.7%–15.2%).ConclusionsCurrent medical evidence on EVT in patients with colorectal leaks lacks high quality data from RCTs. Based on the data available, EVT can be seen as a feasible treatment option with manageable risks for selected patients with colorectal leaks.
Highlights
Since the first reported data in the late 1990s, vacuum-assisted wound therapy has captured nearly every field of surgery by providing a versatile and easy-to-handle method for Florian Kühn and Josefine Schardey contributed .In the further course, endoscopic vacuum therapy (EVT) has been successfully applied for interventional treatment of different defects in the upper and lower gastrointestinal tract [3]
The following search strategy was used in PubMed, Embase, and Cochrane Database according to the PRISMA checklist [34]: (((((((((EVT) OR) OR) OR) OR) OR) OR (Endo-sponge)) OR) OR (Endo-vac)) OR (Endovac))
Random effects meta-analysis showed that the weighted mean success rate of EVT was 81.4% (Fig. 3)
Summary
Since the first reported data in the late 1990s, vacuum-assisted wound therapy has captured nearly every field of surgery by providing a versatile and easy-to-handle method for Florian Kühn and Josefine Schardey contributed .In the further course, EVT has been successfully applied for interventional treatment of different defects in the upper and lower gastrointestinal tract [3]. Preliminary reports showed promising results for EVT in the treatment of colorectal leaks with high success rates and anastomotic salvage, data determining the superiority of EVT over other forms of conservative treatment in diverted anastomoses is lacking [5, 6]. As mostly small case series are published in this field, the aim of our systematic review and meta-analysis was to evaluate the efficacy and safety of EVT in the treatment of colorectal leaks. Methods A systematic search of MEDLINE/PubMed and Cochrane databases was performed using search terms related to EVT and colorectal defects (anastomotic leakage, rectal stump insufficiency) according to the PRISMA guidelines. Twenty-four studies reporting on 690 patients with colorectal defects undergoing EVT were included. Sixty-four patients were reported with EVT-associated complications, the weighted mean complication rate across the studies was 12.1% (95% CI: 9.7%–15.2%). Based on the data available, EVT can be seen as a feasible treatment option with manageable risks for selected patients with colorectal leaks
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