Alternative techniques for treating nonmalignant leaks, perforations, and ruptures

Endoscopic management of nonmalignant leaks, perforations, and ruptures becomes increasingly important with the growing availability of endoscopic therapy. In general, treatment strategies depend on the time of intervention (immediate complication management vs therapy of chronic fistulas and leaks). The approach used to close an acute perforation is adopted from surgical closure techniques, although a serosa-to-serosa adaptation is difficult to achieve, even with new devices. Nonacute leaks-if not treated by stents-are more complex and treatment is based on secondary wound closure after implantation of certain materials and devices. Nevertheless, apart from these general considerations it is important to know that therapy is not standardized and is therefore often based on a patient's individual factors, availability of respective devices, and knowledge in handling them.