Surgical endoscopy · 2026
Endoscopic negative-pressure therapy for anastomotic leaks after upper gastrointestinal surgery: systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Gómez Santiago Alonso, Garrido María Donat, Molina Carlos Miliani, Cortijo Sagrario Martínez, Cuellar Elías Rodríguez, Herrero Eduardo Ferrero, Dagnesses-Fonseca Javier
Аннотация
BACKGROUND: UGI anastomotic leaks are severe postoperative complications associated with substantial morbidity, mortality, and prolonged hospitalization. EVT is a minimally invasive alternative to conventional approaches, but evidence has not been comprehensively synthesized.
METHODS: This systematic review and meta-analysis was reported in accordance with the PRISMA 2020 statement. Observational studies (January 2015-January 2025) identified in PubMed, Embase, Cochrane, and LILACS. Adults with UGI anastomotic leaks treated with EVT were eligible. Random-effects models pooled proportions using the Freeman-Tukey double-arcsine transformation; sensitivity analyses used a logit transformation. Pre-specified subgroup analyses stratified by surgical indication (oncologic, bariatric, mixed), leak location (intrathoracic vs intra-abdominal), and risk of bias. Risk of bias was appraised using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series and certainty of evidence with GRADE.
RESULTS: Thirty-one studies (n = 767) were included. The pooled clinical success was 87% (95% CI, 82-91%) and remained high in sensitivity analyses (84-89%). No material differences were observed across oncologic, bariatric, or mixed series. Intrathoracic leaks showed lower success than intra-abdominal leaks (79 vs 95%). Thirty-day mortality was 7%, primarily in complex clinical contexts. Heterogeneity was substantial, and small-study effects were suspected. Overall certainty of evidence was rated low owing to observational design and risk of bias.
CONCLUSIONS: Across observational studies, EVT achieved high clinical success for UGI anastomotic leaks with low short-term mortality. Prospective cohorts and randomized trials are needed to refine indications, identify predictors of response, and assess cost-effectiveness.
METHODS: This systematic review and meta-analysis was reported in accordance with the PRISMA 2020 statement. Observational studies (January 2015-January 2025) identified in PubMed, Embase, Cochrane, and LILACS. Adults with UGI anastomotic leaks treated with EVT were eligible. Random-effects models pooled proportions using the Freeman-Tukey double-arcsine transformation; sensitivity analyses used a logit transformation. Pre-specified subgroup analyses stratified by surgical indication (oncologic, bariatric, mixed), leak location (intrathoracic vs intra-abdominal), and risk of bias. Risk of bias was appraised using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series and certainty of evidence with GRADE.
RESULTS: Thirty-one studies (n = 767) were included. The pooled clinical success was 87% (95% CI, 82-91%) and remained high in sensitivity analyses (84-89%). No material differences were observed across oncologic, bariatric, or mixed series. Intrathoracic leaks showed lower success than intra-abdominal leaks (79 vs 95%). Thirty-day mortality was 7%, primarily in complex clinical contexts. Heterogeneity was substantial, and small-study effects were suspected. Overall certainty of evidence was rated low owing to observational design and risk of bias.
CONCLUSIONS: Across observational studies, EVT achieved high clinical success for UGI anastomotic leaks with low short-term mortality. Prospective cohorts and randomized trials are needed to refine indications, identify predictors of response, and assess cost-effectiveness.