Current status in endoscopic management of upper gastrointestinal perforations, leaks and fistulas

Recent advancement in endoscopic closure techniques have revolutionized the treatment of gastrointestinal perforations, leaks and fistulas. Traditionally, these have been managed surgically. The treatment strategy depends on the size and location of the defect, degree of contamination, presence of h...

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Bibliographic Details
Published in:Digestive endoscopy 2022-01, Vol.34 (1), p.43-62
Main Authors: Chan, Shannon Melissa, Auyeung, Kitty Kit Ying, Lam, Siu Fung, Chiu, Philip Wai Yan, Teoh, Anthony Yuen Bun
Format: Article
Language:English
Subjects:
anastomotic leak
Anastomotic Leak - surgery
Endoscopy
Fistula
gastrointestinal perforation
Humans
Stents
Treatment Outcome
Upper Gastrointestinal Tract
wound closure technique
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Summary:Recent advancement in endoscopic closure techniques have revolutionized the treatment of gastrointestinal perforations, leaks and fistulas. Traditionally, these have been managed surgically. The treatment strategy depends on the size and location of the defect, degree of contamination, presence of healthy surrounding tissues, patients’ condition and the availability of expertise. One of the basic principles of management includes providing a barricade to the flow of luminal contents across the defect. This can be achieved with a wide range of endoscopic techniques. These include endoclips, stenting, suturing, tissue adhesives and glue, and endoscopic vacuum therapy. Each method has their distinct indications and shortcomings. Often, a combination of these techniques is required. Apart from endoscopic closure, drainage procedures by the interventional radiologist and surgical management also play an important role. In this review article, the outcomes of each of these endoscopic closure techniques in the literature is provided in tables, and practical management algorithms are being proposed.
ISSN:0915-5635
1443-1661
DOI:10.1111/den.14061