Anastomotic fistula is one of the most severe complications after digestive tract surgery. At present, endoscopic treatment for anastomotic fistula is developing gradually, and it has many advantages such as safety, minimally invasiveness, low cost of treatment compared with traditional surgery. The treatment methods include endoscopic jejunal nutrition tube placement, metal clip closure, stent placement, tissue sealants, suturing, vacuum-assisted closure therapy. The relevant characteristics of them include: jejunal nutrition tube can effectively improve the nutritional status of the patients; through-the-scope clip combined with nylon rope trap has advantages in the treatment of anastomotic fistula with diameter less than 1.0 cm; over-the-scope clip is suitable for anastomotic fistula with large defect and high tension; endoscopic stent can cover the fistula orifice entirely and control the leakage early, and it has a higher benefit for patients at risk of stenosis of the lumen, but stent displacement, removal difficulties and other circumstances are possibly occur; tissue sealant combined with endoscopic clip or stent can improve the success rate of leak occlusion; endoscopic suturing is safe and effective in preventing stent displacement; endoscopic vacuum-assisted closure therapy can sufficiently drain the inflammatory environment around the leakage, and has better applicability for anastomotic leak patients with secondary mediastinitis or intrathoracic inflammation. Endoscopic minimally invasive treatment of anastomotic fistula can avoid repeated operation and be the preferred treatment option for some patients.