Endoscopic management of gastrointestinal leaks and fistulae: What option do we have?

Table 1 Definition of leak and fistula

	Definition
Leak	Pathological communication between intra and extra-luminal compartments
Fistula	Abnormal communication between two epithelialized surfaces

Table 2 Main features of the different endoscopic approaches to leak and fistula

	Mechanism ofaction	Advantages	Disadvantages	Cost	N° of sessions	Expertise needed
Endoclips	Direct closure	More effective in acute setting	Less effective in chronic setting; Need of external drainage	+	+	+
Stent	Defect sealing	Early oral intake; Reduce stricture formation	Stent migration; Tissue ingrowth/overgrowth pain; Need of externaldrainage	++	+	++
EID	Second intention closure	Early oral intake; Internal drainage; More effective in acute setting	Stricture	+	++	++
Suturing system	Direct closure	True full-thickness closure; Single operator (Overstich®)	On healthy tissue; More difficult in tight endoluminal space and tangential suturing site	+++	+	+++
EVT	Second intention closure	Continuous drainage; More effective in early stage	Limited to rectal/esophageal site; Need of de-functioning stoma; Less effective if late diagnosis	+	+++	+
Tissue sealant	Miscellaneous	Antibacterial (cyanoacrylate); Used in combination; No inflammatory reaction (Surgisis®)	On dry areas (fibrin glue); Inflammatory reaction (cyanoacrylate/fibrin glue)	+	++	+

EID: Endoscopic internal drainage; EVT: Endoluminal vacuum therap.