Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 25, 2015; 7(7): 702-713
Published online Jun 25, 2015. doi: 10.4253/wjge.v7.i7.702
Endotherapy of leaks and fistula
Mahesh Kumar Goenka, Usha Goenka
Mahesh Kumar Goenka, Institute of Gastro Sciences, Apollo Gleneagles Hospitals, Kolkata 700054, India
Usha Goenka, Department of Imaging and Interventional Radiology, Apollo Gleneagles Hospitals, Kolkata 700054, India
Author contributions: Both the authors contributed to this manuscript.
Conflict-of-interest: We hereby declare that that we have no conflict of interest in relation to this review article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mahesh Kumar Goenka, MD, DM, FACG, FASGE, Director, Institute of Gastro Sciences, Apollo Gleneagles Hospitals, 58 Canal Circular Road, Kolkata 700054, India. mkgkolkata@gmail.com
Telephone: +91-33-23203040 Fax: +91-33-23205218
Received: October 28, 2014
Peer-review started: November 1, 2014
First decision: February 7, 2015
Revised: March 5, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: June 25, 2015
Processing time: 252 Days and 14.2 Hours
Abstract

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.

Keywords: Fistula; Leak; Perforation; Post operative; Endoscopy; Endoscopic; Surgery; Stent; Suture; Endoclip; Clip

Core tip: Gastrointestinal (GI) leaks and fistula are increasingly recognized in our day to day practice. While these patients were earlier managed by surgical interventions, more and more such patients are now considered for endoscopic therapy. Endotherapy for GI leaks include endoclips (through the scope and over the scope), covered stents, fibrin glue, suture devices and more recently introduced endoscopic vacuum therapy using bioactive sponge. Since the experience with these modalities is limited, there are hardly any clear guidelines to treat these difficult patients. This review article deals with endotherapy of GI leaks and fistula and presents an updated experience as well some guidance to select appropriate modality.