Endoscopic and Hybrid Rescue of Postoperative Gastrointestinal Leaks and Anastomotic Defects

Anastomotic leaks and other postoperative defects remain among the most feared complications of gastrointestinal surgery. They can occur at any level, from the esophagus to the rectum, after esophagectomy, gastrectomy, bariatric surgery, pancreatic and hepatobiliary resection, small bowel surgery, and colorectal resection. They increase morbidity, lengthen hospital stay, and raise mortality. They also lead to permanent stomas, chronic fistulas, and a lower quality of life. For many years, reoperation, diversion, or prolonged drainage were the standard responses. Today, a growing set of minimally invasive tools offers an organ-preserving alternative.Endoscopic techniques have changed how surgeons and endoscopists manage these complications. Through-the-scope and over-the-scope clips, covered self-expanding stents, endoscopic vacuum therapy, internal drainage with double-pigtail stents, and endoscopic suturing now allow early defect closure and source control. Hybrid strategies go further by combining endoscopic, laparoscopic, transanal, radiological, and percutaneous steps. Examples include endoscopic vacuum therapy with laparoscopic washout, endo-laparoscopic rendezvous procedures, transanal approaches for low colorectal leaks, and image-guided drainage paired with luminal sealing. Key questions remain open. These include the best timing of intervention, how to select patients, which technique suits which defect and which site, and how to define success.This Research Topic brings together surgeons, gastroenterologists, interventional endoscopists, and radiologists to share evidence and experience on rescue strategies across the whole gastrointestinal tract. We aim to move from single-center experience toward comparable data and clear recommendations. We invite submissions on, but not limited to, the following themes:• Early detection and risk stratification of leaks, including biomarkers, imaging, and clinical scores• Endoscopic vacuum therapy: indications, technical variations, and outcomes at upper and lower GI sites• Stents, clips, and endoscopic suturing: comparative effectiveness and failure modes• Hybrid and multidisciplinary pathways combining endoscopic, surgical, transanal, and percutaneous approaches• Management of chronic leaks, fistulas, anastomotic strictures, and sinus tracts• Leak management after esophageal, gastric, small bowel, colonic, rectal, and low colorectal anastomoses• Timing, decision-making, and the choice between salvage and reoperation• Nutrition, sepsis control, and perioperative optimization during rescue therapy• Functional outcomes, stoma-free survival, and quality of life• Cost-effectiveness, training, and the learning curve for advanced endoscopic techniques• Artificial intelligence and novel technologies in leak prediction and endoscopic assessmentWe welcome, but are not limited to, Original Research, Systematic Reviews, Meta-Analyses, Clinical Trials, Technical Notes, Case Series, Perspectives, and Reviews. Studies that report standardized definitions, clinically relevant outcomes, and long-term follow-up are especially encouraged.By collecting high-quality evidence in one place, this Research Topic aims to support practical algorithms for managing postoperative defects, encourage collaboration between surgical and endoscopic teams, and improve outcomes for patients. Topic editors: Gaetano Gallo, Gabriel Sandblom Source: https://www.frontiersin.org/research-topics/87417/endoscopic-and-hybrid-rescue-of-postoperative-gastrointestinal-leaks-and-anastomotic-defects