INTRODUCTION:

Endoluminal vacuum therapy (EVT) using polyurethane sponges represents a minimally invasive and effective alternative for the treatment of colorectal anastomotic leaks, with reported closure rates of up to 81%. This approach is based on the endoscopic placement of a sponge connected to a negative pressure system, allowing continuous drainage of secretions, reduction of the residual cavity, and stimulation of granulation tissue formation. Current evidence supports its superiority over conventional management, with higher success rates (RR 1.18), shorter treatment duration, and a better safety profile.

OBJECTIVE:

To describe our experience with endoscopic treatment of colorectal anastomotic leaks using the Endo-SPONGE® system following low anterior resection for rectal adenocarcinoma.

MATERIALS AND METHODS:

A retrospective review was conducted of the indication, treatment, and clinical outcomes of patients managed with EVT at the University Hospital of Araba between 2024 and 2025.

RESULTS:

Five patients were included: four were treated initially with EVT and one after unsuccessful percutaneous drainage. Diagnosis was established by computed tomography and endoscopy, identifying presacral cavities ranging from 3–12 cm with luminal communication. In one case, two Endo-SPONGE® devices were placed simultaneously due to cavity size. Endoscopic sponge exchanges were performed every 48–72 hours, with up to six sessions required in the largest cavity. Complete closure of the cavity, confirmed endoscopically and radiologically, was achieved in three patients, allowing intestinal continuity restoration. One patient remains under treatment after six sessions, and one required surgical rescue.

CONCLUSIONS:

In our experience, EVT is an effective, safe, and minimally invasive strategy for the management of colorectal anastomotic leaks, achieving cavity closure and preservation of intestinal continuity in most cases.