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Meta-Analysis
. 2022 Feb;37(2):283-292.
doi: 10.1007/s00384-021-04066-7. Epub 2021 Nov 24.

Endoscopic vacuum therapy for the treatment of colorectal leaks - a systematic review and meta-analysis

Florian Kühn #  1 , Josefine Schardey #  2 , Ulrich Wirth  1 , Tobias Schiergens  1 , Alexander Crispin  3 , Nicola Beger  1 , Dorian Andrade  1 , Moritz Drefs  1 , Petra Zimmermann  1 , Maria Burian  1 , Joachim Andrassy  1 , Jens Werner  1
Affiliations
Meta-Analysis

Endoscopic vacuum therapy for the treatment of colorectal leaks - a systematic review and meta-analysis

Florian Kühn et al. Int J Colorectal Dis. 2022 Feb.

Abstract

Background: During 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.

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. 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.

Results: Only 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%).

Conclusions: Current 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.

Keywords: Anastomotic leakage; Colorectal defects; EVT; Endoscopic vacuum therapy; Rectal stump leakage.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Funnel plot for assessment of publication bias for the EVT success rate
Fig. 2
Fig. 2
Flow chart of literature selection strategy
Fig. 3
Fig. 3
Forest plot for success rate of EVT across the studies. Success rates are shown with 95% CI
Fig. 4
Fig. 4
Forest plot for any kind of diverting ostomy during EVT across the studies. Diverting ostomy rates are shown with 95% CI
Fig. 5
Fig. 5
Forrest plot for stoma reversal rate after EVT across the studies. Stoma reversal rates are shown with 95% CI
Fig. 6
Fig. 6
Forrest plot for EVT-associated complication rates across the studies. Complication rates are shown with 95% CI
See this image and copyright information in PMC

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