• Autologous emulsified stromal vascular fraction
• Endoscopic suture
• Endoscopic vacuum-assisted closure therapy
• Esophageal perforations
• Lateral esophagostomy
• Metal stent
• Postoperative leak

• Bariatric endoscopy
• Complications
• Fistulas
• Leaks
• Marginal ulcerations
• Ulcerations

• Humans
• Bariatric Surgery/adverse effects
• Bariatric Surgery/methods
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Anastomotic Leak/surgery
• Anastomotic Leak/etiology
• Endoscopy, Gastrointestinal/methods
• Obesity, Morbid/surgery
• Obesity, Morbid/complications
• Gastric Fistula/etiology
• Gastric Fistula/surgery
• Ulcer/etiology
• Ulcer/surgery
• Gastric Bypass/adverse effects
• Gastric Bypass/methods

• conservative treatment
• esophageal stent
• risk factors
• tracheal stent
• tracheoesophageal fistula

• boerhaave syndrome
• spontaneous esophageal rupture
• treatment
• meta-analysis

• Endoscopic treatment
• Endoscopy
• Fistula
• Upper GI
• Upper gastrointestinal

• Esophageal Fistula/diagnostic imaging
• Esophageal Fistula/surgery
• Gastric Fistula/diagnostic imaging
• Gastric Fistula/surgery
• Humans
• Drainage
• Endoscopy, Gastrointestinal/methods
• Upper Gastrointestinal Tract/diagnostic imaging

• Colovesical fistula
• Covered stent
• Self-expanding metallic stent

• Anastomotic leak
• Bariatric surgery
• Endoscopy
• Esophagectomy
• Gastrectomy
• Upper gastrointestinal tract

• Humans
• Retrospective Studies
• Suture Techniques
• Sutures
• Self Expandable Metallic Stents/adverse effects
• Stents
• Esophagoscopy/methods
• Treatment Outcome

• Anastomosis
• Crohn's disease
• Endoscopy
• Ileal pouch
• Inflammatory bowel disease
• Leaks
• Therapy
• Ulcerative colitis

• Abscess
• Crohn disease
• Endoscopic therapy
• Fistula

Surgical techniques for repair of rectovaginal fistula (RVF) have been continually developed, but the ideal procedure remains unclear. Endoscopic repair is a novel and minimally invasive technique for RVF repair with increasing reporting.

To review the current applications and preliminary outcomes of this technique for RVF repair, aiming to give surgeons an alternative in clinical practice.

Available articles were searched according to the search strategy. And the sample size, fistula etiology, fistula type, endoscopic repair approaches, operative time and hospital stay, follow-up period, complication and life quality assessment were selected for recording and further analysis.

A total of 11 articles were eventually identified, involving 71 patients with RVFs who had undergone endoscopic repair. The principal causes of RVFs were surgery (n = 51, 71.8%), followed by obstetrics (n = 7, 9.8%), inflammatory bowel disease (n = 5, 7.0%), congenital (n = 3, 4.2%), trauma (n = 2, 2.8%), radiation (n = 1, 1.4%), and in two patients, the cause was unclear. Most fistulas were in a mid or low position. Several endoscopic repair methods were included, namely transanal endoscopic microsurgery, endoscopic clipping, and endoscopic stenting. Most patients underwent > 1-year follow-up, and the success rate was 40%-93%, and all cases reported successful closure. Few complications were mentioned, while postoperative quality of life assessment was only mentioned in one study.

In conclusion, endoscopic repair of RVF is novel, minimally invasive and promising with acceptable preliminary effectiveness. Given its unique advantages, endoscopic repair can be an alternative technique for surgeons.

• Endoscopic repair
• Minimal-invasive technique
• Rectovaginal fistula

Flexible endoscopy has an important part in the diagnosis and treatment of postoperative complications after oncologically intended esophagectomy. Endoscopy offers the possibility of effective therapy with minimal invasiveness at the same time, and the use of endoscopic therapy procedures can avoid re-operations. In this review we present the advantages of endoscopic treatment opportunities during the last 20 years regarding patients’ treatment after esophageal cancer resection. According to prevalence and clinical relevance, four relevant postoperative complications were identified and their endoscopic treatment procedures discussed. All endoscopic therapy procedures for anastomotic bleeding, anastomotic insufficiencies, anastomotic stenosis and postoperative delayed gastric emptying are presented, including innovative developments.

Background: Esophageal cancer (EC) is the sixth-leading cause of cancer-related deaths in the world. Esophagectomy is the most effective treatment for patients without invasion of adjacent organs or distant metastasis. Complications and relevant problems may occur in the early post-operative course or in a delayed fashion. Here, innovative endoscopic techniques for the treatment of postsurgical problems were developed during the past 20 years. Methods: Endoscopic treatment strategies for the following postoperative complications are presented: anastomotic bleeding, anastomotic insufficiency, delayed gastric passage and anastomotic stenosis. Based on a literature review covering the last two decades, therapeutic procedures are presented and analyzed. Results: Addressing the four complications mentioned, clipping, stenting, injection therapy, dilatation, and negative pressure therapy are successfully utilized as endoscopic treatment techniques today. Conclusion: Endoscopic treatment plays a major role in both early-postoperative and long-term aftercare. During the past 20 years, essential therapeutic measures have been established. A continuous development of these techniques in the field of endoscopy can be expected.

• endoscopic complication management
• esophageal cancer
• postsurgical complication

• anastomotic leak
• fistula
• gastrointestinal perforation
• wound closure technique

• Endoscopic suturing
• Endoscopy
• Esophageal fistula
• Esophageal perforation
• Esophageal stents
• Post op leaks

To explore the comprehensive role of systemic endoscopic intervention in healing esophageal anastomotic leak.

In total, 3919 consecutive patients with esophageal cancer who underwent esophagectomy and immediate esophageal reconstruction were screened. In total, 203 patients (5.10%) diagnosed with anastomotic leakage were included. The participants were divided into three groups according to differences in diagnosis and treatment procedures. Ninety-four patients received conventional management, 87 patients received endoscopic diagnosis only, and the remaining 22 patients received systematic endoscopic intervention. The primary endpoint was overall healing of the leak after oncologic esophageal surgery. The secondary endpoints were the time from surgery to recovery and the occurrence of adverse events.

173 (85.2%; 95% CI, 80.3-90.1%) of the 203 patients were successfully healed, with a mean healing time of 66.04 ± 3.59 days (median: 51 days; range: 13-368 days), and the overall healing rates differed significantly among the three groups according to the stratified log-rank test (P<0.001). The median healing time of leakage was 37 days (95% CI: 33.32-40.68 days) in the endoscopic intervention group, 51 days (95% CI: 44.86-57.14 days) in the endoscopic diagnostic group, and 67 days (95% CI: 56.27-77.73 days) in the conventional group. The overall survival rate was 78.7% (95% CI: 70.3 to 87.2%) in the conventional management group, 89.7% (95% CI: 83.1 to 96.2%) in the endoscopic diagnostic group and 95.5% (95% CI: 86.0 to 100%) in the systematic endoscopic intervention group. Landmark analysis indicated that the speed of wound healing in the endoscopic intervention group was 2-4 times faster at any period than that in the conservative group. There were 20 (21.28%) deaths among the 94 patients in the conventional group, 9 (10.34%) deaths among the 87 patients in the endoscopic diagnostic group and 1 (4.55%) death among the 22 patients in the endoscopic intervention group; this difference was statistically significant (Fisher exact test, P < 0.05).

Tailored endoscopic treatment for postoperative esophageal anastomotic leakage based on endoscopic diagnosis is feasible and effective. Systematic endoscopic intervention shortened the treatment period and reduced mortality and should therefore be considered in the management of this disease.

• anastomotic leak
• clips
• endoscopic intervention
• esophageal cancer
• perioperative complications
• sealants

• CSDO, cardiac septal defect occluder

• Anastomotic Leak/therapy
• Esophageal Perforation/therapy
• Esophagus/surgery
• Humans
• Metals
• Plastics
• Stents/adverse effects

• Bariatric surgery
• fully covered self-expandable metal stent
• laparoscopic sleeve gastrectomy
• leak
• stenosis

• Achalasia cardia
• Benign stricture
• Esophageal foreign body
• Esophageal leaks
• Esophageal perforation
• Esophagectomy
• Iatrogenic
• Mediastinitis
• Therapeutic endoscopy

• Anastomotic Leak/surgery
• Esophageal Perforation/surgery
• Female
• Follow-Up Studies
• Humans
• Male
• Minimally Invasive Surgical Procedures/methods
• Self Expandable Metallic Stents/adverse effects
• Time Factors
• Treatment Outcome

• Bariatric Surgery/adverse effects
• Endoscopy, Gastrointestinal
• Gastric Bypass
• Gastroplasty/adverse effects
• Humans
• Obesity, Morbid/surgery
• Practice Guidelines as Topic
• Retrospective Studies
• Treatment Outcome

Gastrointestinal leaks and fistulae are serious, potentially life threatening conditions that may occur with a wide variety of clinical presentations. Leaks are mostly related to post-operative anastomotic defects and are responsible for an important share of surgical morbidity and mortality. Chronic leaks and long standing post-operative collections may evolve in a fistula between two epithelialized structures. Endoscopy has earned a pivotal role in the management of gastrointestinal defects both as first line and as rescue treatment. Endotherapy is a minimally invasive, effective approach with lower morbidity and mortality compared to revisional surgery. Clips and luminal stents are the pioneer of gastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closure devices and techniques, such as endoscopic internal drainage, suturing system and vacuum therapy, has broadened the indications of endoscopy for the management of GI wall defect. Although several endoscopic options are currently used, a standardized evidence-based algorithm for management of GI defect is not available. Successful management of gastrointestinal leaks and fistulae requires a tailored and multidisciplinary approach based on clinical presentation, defect features (size, location and onset time), local expertise and the availability of devices. In this review, we analyze different endoscopic approaches, which we selected on the basis of the available literature and our own experience. Then, we evaluate the overall efficacy and procedural-specific strengths and weaknesses of each approach.

• Leak
• Fistula
• Endotherapy
• Over-the-scope clip
• Suturing system
• Endo-vacuum therapy
• Endoscopic internal drainage
• Self-expandable metal stent

• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Endoscopes
• Endoscopy
• Endoscopy, Gastrointestinal
• Fistula
• Humans
• Surgical Instruments
• Treatment Outcome

• Adult
• Deglutition Disorders/epidemiology
• Deglutition Disorders/etiology
• Deglutition Disorders/therapy
• Esophageal Neoplasms
• Esophageal Stenosis/epidemiology
• Esophageal Stenosis/surgery
• Humans
• Stents
• Treatment Outcome

The radial force of esophageal stents may not completely change during extraction and therefore, the procedure of stent removal may cause tissue damage. The present study reports the manufacture of 2 novel detachable stents, which were designed to reduce tissue damage through their capacity to be taken or fall apart prior to removal and evaluated the supporting properties of these stents and the extent of local mucosal injury during their removal. The stents were manufactured by braiding, heat-setting, coating and connecting. The properties of the stents were evaluated by determining the following parameters: Expansion point, softening point, stent flexibility, radial compression ratio and radial force. A total of 18 rabbits with induced esophageal stricture were randomly assigned to 3 groups as follows: Detachable stent (DS) group, biodegradable stent (BS) group and control group. The stricture rate, complications, survival, degradation and stent removal were observed over 8 weeks. The stents of the DS and BS groups provided a similar supporting effect. The stricture rate, incidence of complications and survival were also similar between the 2 groups, while significant differences were noted between the DS and control groups and between the BS and control groups. In the BS group, the stents were degraded and moved to the stomach within 7 weeks (2 in 6 weeks and 3 in 7 weeks). The debris was extracted using biopsy forceps. In the DS group, all stents were easy to remove and 2 cases exhibited minor hemorrhage. In conclusion, the 2 types of novel detachable stent provided an equally efficient supporting effect in vitro and in vivo and may reduce the incidence of secondary injury during stent removal.

• animal experimentation
• endoscopic procedure
• esophageal stricture
• stents

Spontaneous esophageal perforation is a potentially life-threatening condition with high morbidity and mortality rates. While surgical treatment has been employed for esophageal perforation, we have adopted conservative treatment with an esophageal stent for patients in a poor physical condition because we consider controlling sepsis and improving the physical status are the highest priorities; additionally, the surgical trauma could be fatal for these patients.

A 60-year-old male complaining of left chest and back pain after vomiting was transferred to a local hospital. Computed tomography and chest X-ray examinations showed left tension pneumothorax, pneumomediastinum, and bilateral pleural effusion suspicious of spontaneous intrathoracic esophageal perforation. He was transferred to our hospital for further treatment. After arrival, he developed septic shock with acute respiratory failure. We considered that surgical treatment was too invasive and chose conservative treatment with an esophageal stent. Under general anesthesia, we first inserted a 20-Fr. trocar in the left posterior pleural space, and a large volume of the dark pleural effusion was discharged. We then performed endoscopy and found a pinhole perforation in the left posterolateral wall of the lower esophagus. We inserted both a silicon-covered esophageal stent with a check valve and a double elemental diet (W-ED) tube. We then inserted an 18-Fr. trocar into the left anterior wall. These procedures were performed less than 24 h after onset. As intensive medical care, the patient was administered broad-spectrum antibiotics and catecholamine. The two trocars and the W-ED tube were under continuous suction at − 5 cmH₂O and at − 20 cmH₂O every 30 s. On the 6th day, we inserted an additional thoracic drainage tube into the left pleura under CT guidance. The patient was discharged from the ICU to the general ward on the 7th day. We removed the stent almost triweekly, and the esophageal perforation was completely healed on the 45th day. He was discharged home on the 70th day.

Conservative treatment with a temporary self-expanding covered stent with a check valve, sufficient drainage, and W-ED tube nutrition was useful and effective in this unstable case of spontaneous intrathoracic esophageal perforation.

• Conservative treatment
• Covered esophageal stent with a check valve
• Spontaneous intrathoracic esophageal perforation

• Esophagectomy
• anastomotic leak
• esophageal cancer

• Endoluminal clips
• Endoluminal therapy
• Endoluminal vacuum therapy
• Endoscopic vacuum therapy
• Esophageal perforation
• Esophageal stents

• Brachytherapy
• Dysphagia
• Oesophageal neoplasms
• Palliative care
• Radiotherapy
• Self-expandable metallic stents

• Fibrin glue
• Fistula
• Polyglycolic acid sheet

• Absorbable Implants
• Aged
• Digestive System Fistula/diagnostic imaging
• Digestive System Fistula/therapy
• Endoscopy, Gastrointestinal/methods
• Female
• Humans
• Male
• Middle Aged
• Polyglycolic Acid/therapeutic use
• Retrospective Studies
• Tissue Adhesives/therapeutic use
• Treatment Outcome

• Fistula
• Leak
• Lumen-apposing metal stent

• Benign esophageal perforations
• Esophageal carcinoma
• Esophageal stents
• Esophago-respiratory fistula
• Refractory benign esophageal stricture
• Stent migration

• anastomotic leakage
• esophageal stricture
• perforation
• rescue esophagectomy
• rupture
• self-expanding metal stent
• treatment failure

• drainage
• endoscopy
• esophageal perforation
• esophagostomy
• stents
• wounds and injuries

• Abdominal Abscess/etiology
• Abdominal Abscess/surgery
• Crohn Disease/complications
• Crohn Disease/surgery
• Drainage/methods
• Endoscopy, Gastrointestinal/methods
• Female
• Humans
• Intestinal Fistula/etiology
• Intestinal Fistula/surgery
• Male
• Rectal Fistula/surgery
• Rectovaginal Fistula/surgery

• Boerhaave’s syndrome
• Endoscopic clip
• Endoscopic vacuum therapy
• Esophageal anastomotic leakage
• Esophageal benign perforation
• Esophageal stent