Anastomotic leakage is a serious complication with significant morbidity and mortality. The popularity of endoscopic treatment (Endo-SPONGE) is increasing for distally located colorectal pouch-anal anastomotic leakages. This was a retrospective study of 15 cases involving the application of the Endo-SPONGE for anastomotic leakage following proctectomy between May 2009 and May 2014. Of the 15 cases, lower anterior resection occurred in 12 cases (80%), and pouch-anal anastomosis in 3 cases (18%). In 8 patients (55%), the endosponge was applied during the early term, and in 7 patients (45%) during the late term. The average number of applications was 2.2 (range, 1 to 5). Treatment was discontinued due to the progression of pelvic sepsis in 2 patients and due to bleeding in 1 patient. Lumen integrity was achieved in 12 cases. Lumen integrity after anastomotic leakages can be preserved by endoluminal vacuum therapy, which permits the closure of the stoma without requiring reconstructive surgery.