The role of endoscopy in anastomotic leaks - Video

Title: The role of endoscopy in anastomotic leaks
Speaker: Siwan Thomas Gibson
Event: Frontiers in Colorectal and Intestinal Disease 2024
Year: 2024

Siwan Thomas-Gibson presents an evolving endoscopic approach to managing colorectal anastomotic leaks and fistulas, particularly through the combined use of over‑the‑scope clips and tissue adhesives. She emphasises that these cases often involve significant uncertainty and require multidisciplinary collaboration, especially with interventional radiology. Through several detailed case examples, she illustrates how small, well‑defined fistula openings may be amenable to endoscopic closure when surgery carries high risk or has already failed.

In the first case, a comorbid patient with a persistent colo‑vesical fistula underwent fluoroscopy‑guided glue instillation followed by clip placement, achieving radiological and clinical resolution that enabled later stoma reversal. A second case involving a young patient with FAP and a pouch leak demonstrated similar technical success, with cessation of recurrent sepsis following combined therapy. The speaker notes the technical challenges of the method, including limited visibility once the clip cap is mounted and difficulty accessing low or awkwardly positioned defects. She also describes a case in which the fistula aperture was too large for successful closure, underscoring the importance of careful patient selection. Overall, she concludes that while promising, the technique has a learning curve and is best applied to small‑diameter defects within a consistent multidisciplinary framework.