Therapeutic flexible endoscopy replacing surgery: Part 1—Leaks and fistulas

Flexible endoscopy has become an integral part of managing many surgical problems that in the past required open or laparoscopic surgical interventions. Stents, clips, suturing devices, glues, and vacuum systems can be used to control perforations, leaks, and fistulas in properly selected patients. Stents have gained place in the treatment algorithm for patients with esophageal perforation from various causes. Endoscopic clips are being used to close perforations in the gastrointestinal tract in addition to their use for bleeding. The technology is slowly evolving and larger clips are available for over-the-scope use. Early perforations and leaks can be managed with clips. Various suturing devices are available for endoscopic suturing mainly for upper gastrointestinal tract. Many of the devices were initially designed for antireflux procedures and are used for closure of perforations and fistulas. The research in closure techniques for enterotomies in natural orifice surgery has expanded its role in the management of iatrogenic perforations. In this article, we review the current literature and describe the role of flexible endoscopy for treatment of leaks and fistulas.