Published online Jul 10, 2015. doi: 10.4253/wjge.v7.i8.758
Peer-review started: January 29, 2015
First decision: March 6, 2015
Revised: March 26, 2015
Accepted: May 5, 2015
Article in press: May 8, 2015
Published online: July 10, 2015
Processing time: 166 Days and 12.4 Hours
Full thickness gastrointestinal defects such as perforations, leaks, and fistulae are a relatively common result of many of the endoscopic and surgical procedures performed in modern health care. As the number of these procedures increases, so too will the number of resultant defects. Historically, these were all treated by open surgical means with the associated morbidity and mortality. With the recent advent of advanced endoscopic techniques, these defects can be treated definitively while avoiding an open surgical procedure. Here we explore the various techniques and tools that are currently available for the treatment of gastrointestinal defects including through the scope clips, endoscopic suturing devices, over the scope clips, sealants, endoluminal stents, endoscopic suction devices, and fistula plugs. As fistulae represent the most recalcitrant of defects, we focus this editorial on a multimodal approach of treatment. This includes optimization of nutrition, treatment of infection, ablation of tracts, removal of foreign bodies, and treatment of distal obstructions. We believe that by addressing all of these factors at the time of attempted closure, the patient is optimized and has the best chance at long-term closure. However, even with all of these factors addressed, failure does occur and in those cases, endoscopic therapies may still play a role in that they allow the patient to avoid a definitive surgical therapy for a time while nutrition is optimized, and infections are addressed.
Core tip: Endoscopic methods are replacing surgical options as the first line therapy for a wide array of gastrointestinal tract defects. Here we will review the available endoscopic modalities, their appropriate applications and their respective success rates. The fusion of standard surgical principles with flexible, intra-luminal modalities is likely to be the key to the successful endoscopic management of these challenging clinical problems.