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World J Gastrointest Endosc
2015[Jun]; 7
(7
): 702-13
PMID26140097
show ga
Perforations, leaks and fistula involving gastrointestinal (GI) tract are
increasing encountered in clinical practice. There is a changing paradigm for
their management with surgical approach being replaced by conservative approach
including endoscopic therapy. Clips (through the scope and over the scope) and
covered stent are front runners for endotherapy for GI leaks and fistula. Over
the scope clips introduced recently, can treat larger defects compared to through
the scope clips. Covered stents are suited for larger defects and those
associated with luminal narrowing. However cervical esophagus, gastro-esophageal
junction, stomach and right colonic lesions may be better for clip therapy rather
than stenting. Recent developments in this field include use of endovac therapy
which consists of a sponge with suction device, biodegradable stent, use of
fibrin glue and some endo-suturing device. Conservative therapy with no surgical
or endoscopic intervention, may be suitable for a small subset of patients. An
algorithm based on location, size of defect, associated stricture, infection and
available expertise needs to be developed to reduce the mortality and morbidity
of this difficult clinical problem.
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