Endo-SPONGE Analysis Shows Device Effective in Treating Colorectal Anastomotic Leaks
Douglas K. Rex, MD, MASGE, reviewing Dhindsa BS, et al. Endosc Int Open 2021 Sep.
Anastomotic leak after low anterior resection is a dreaded complication. Patients with generalized peritonitis must undergo surgery, and treatment of localized walled-off leaks is not standardized. Endo-SPONGE (B Braun, Meslungen, Germany) is an endoscopically placed sponge connected to a vacuum tube and exchanged every 2 to 3 days for a smaller sponge as the size of the cavity decreases and granulation tissue formation increases.
This study identified 17 cohort Endo-SPONGE reports defining technical success, clinical success, and adverse events. There were 384 patients, with technical success of placement in 99.86%. The pooled rate of adverse events was 7.7%, with recurrent abscess and bleeding the most common. Of the adverse events, 60% were rated mild, and 36% were rated moderate. There were no perforations. The clinical success rate for closure of the leak was 85%.
Results of individual reports indicate that early sponge placement (≤15 days) had a higher clinical success rate than initiation after 15 days. Neoadjuvant chemoradiation appeared to be associated with larger cavity sizes and the need for longer treatment courses. In one study, diversion reversal rates improved from 38% with conservative treatment to 87% with sponge treatment.
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COMMENTAlthough not actively controlled, these studies present strong evidence that Endo-SPONGE is a safe and effective method to use for closing colorectal anastomotic leaks.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Dhindsa BS, Naga Y, Saghir SM, et al. Endo-sponge in management of anastomotic colorectal leaks: a systematic review and meta-analysis. Endosc Int Open 2021;09:E1342-E1349. (https://doi.org/10.1055/a-1490-8783)