# Infection-targeted innovations in anastomotic leak management: endoscopic advances, antimicrobial biomaterials, and precision strategies

## TL;DR

This paper reviews new infection-focused strategies for managing anastomotic leaks after gastrointestinal surgery, including endoscopic treatments and smart biomaterials.

## Contribution

The paper highlights novel infection-targeted innovations and their potential to shift AL management from reactive to proactive prevention.

## Key findings

- Endoscopic Vacuum Therapy shows high fistula closure rates and reduced sepsis risk.
- Antibiotic-eluting hydrogels and AI-driven models show promise but need clinical validation.
- Future AL management may integrate endoscopic and biomaterial-based approaches.

## Abstract

Anastomotic leakage (AL) is a devastating complication of gastrointestinal surgery and a critical source of hospital-acquired infections. This review synthesizes recent advances in AL management, with a focus on infection-targeted strategies. A narrative review of the literature was conducted, encompassing established clinical therapies and emerging preclinical innovations. For mature endoscopic modalities, such as Endoscopic Vacuum Therapy (EVT), clinical cohort data and meta-analyses support high fistula closure rates (74–94.4%) and a significant reduction in sepsis risk. In parallel, novel preclinical strategies—including antibiotic-eluting hydrogels, reversible endoscopic bypass procedures, and artificial intelligence-driven prediction models—demonstrate transformative potential in early-stage studies but require robust clinical validation. The future management of AL is evolving towards an integrated model, combining evidence-based endoscopic interventions with intelligent biomaterial-based approaches. Translating preclinical innovations into practice will necessitate overcoming challenges related to cost, standardization, and long-term safety, ultimately enabling a paradigm shift from reactive repair to proactive, precision prevention.