Infection-targeted innovations in anastomotic leak management: endoscopic advances, antimicrobial biomaterials, and precision strategies

Anastomotic leakage (AL) is a devastating complication of gastrointestinal surgery and a critical source of hospital-acquired infections. This review synthesizes recent advances in AL management, with a focus on infection-targeted strategies. A narrative review of the literature was conducted, encompassing established clinical therapies and emerging preclinical innovations. For mature endoscopic modalities, such as Endoscopic Vacuum Therapy (EVT), clinical cohort data and meta-analyses support high fistula closure rates (74-94.4%) and a significant reduction in sepsis risk. In parallel, novel preclinical strategies-including antibiotic-eluting hydrogels, reversible endoscopic bypass procedures, and artificial intelligence-driven prediction models-demonstrate transformative potential in early-stage studies but require robust clinical validation. The future management of AL is evolving towards an integrated model, combining evidence-based endoscopic interventions with intelligent biomaterial-based approaches. Translating preclinical innovations into practice will necessitate overcoming challenges related to cost, standardization, and long-term safety, ultimately enabling a paradigm shift from reactive repair to proactive, precision prevention.