Endoscopic management of fistulas, perforations, and leaks

Although endoscopic management of fistulas, perforations, and leaks is rapidly evolving, management still revolves around the principles of closure, containment, and drainage. Successful endoscopic management is dependent upon several factors, including underlying etiopathogenesis, lesion chronicity, local tissue viability, concurrent illnesses, device availability, and the expertise to deliver the desired endoscopic interventions. Unlike acute perforations, fistulas and leaks typically require a multimodal approach and more than one treatment session to achieve resolution. Although complete resolution remains the goal, endoscopic interventions may enable clinical stabilization of the patient, allow enteral feeding, and facilitate hospital discharge or elective surgery. Herein, we highlight current knowledge and future role of endoscopic interventions in the management of gastrointestinal defects.