Interventional Endoscopy for the Management of Post-Surgical Leaks and Fistulas: A Scoping Review

TL;DR

This review explores how minimally invasive endoscopic techniques are increasingly used to treat post-surgical leaks and fistulas, offering safer alternatives to traditional surgery.

Contribution

The paper provides a comprehensive map of current evidence on endoscopic techniques for managing post-surgical leaks and fistulas.

Findings

Endoscopic vacuum therapy showed the most consistent evidence, especially for esophageal and colorectal leaks.

Technical and clinical success rates varied widely depending on factors like defect characteristics and operator experience.

The evidence base remains heterogeneous and largely based on retrospective studies.

Abstract

Background/Objectives: Leaks and fistulas are serious surgical complications associated with substantial morbidity and mortality. Traditional management has relied on surgical reintervention or percutaneous drainage, both of which carry significant risks. In recent decades, interventional endoscopy has emerged as a minimally invasive alternative, offering a growing range of therapeutic options. This scoping review aimed to systematically map the available evidence on endoscopic management of post-surgical leaks and fistulas, with a focus on techniques used, indications, outcomes, and gaps in the literature. Methods: This scoping review was conducted according to PRISMA-ScR guidelines. PubMed/MEDLINE, Embase, and Scopus were searched from inception to 5 December 2025. Eligible studies included original studies, systematic reviews, and narrative reviews reporting therapeutic endoscopic interventions for post-surgical leaks or fistulas in any patient population. Case reports and case series with fewer than 20 patients were excluded. Data were charted on study design, surgical context, endoscopic techniques, and reported outcomes. Results: A total of 69 studies were included, comprising 46 original studies involving 2550 patients, along with 11 systematic reviews and 12 narrative reviews. Endoscopic techniques identified included through-the-scope and over-the-scope clipping, stenting, endoscopic vacuum therapy, internal drainage, tissue sealants, endoscopic suturing, and hybrid devices such as VAC-Stent®. Reported technical and clinical success rates varied widely across techniques and clinical settings, influenced by defect characteristics, timing of intervention, anatomical location, and operator experience. Endoscopic vacuum therapy was supported by the most consistent evidence, particularly for esophageal and colorectal leaks. Conclusions: Interventional endoscopy represents an increasingly central component in the management of post-surgical leaks and fistulas, enabling individualized, less invasive treatment strategies. However, the current evidence base remains heterogeneous and largely retrospective, underscoring the need for well-designed, multicenter prospective studies.

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